AUTHOR=Zhang Jiaqi , Chi Chengwei , Tian Simiao , Zhang Shulong , Liu Jihong 

TITLE=Predictors of Permanent Pacemaker Implantation in Patients After Transcatheter Aortic Valve Replacement in a Chinese Population

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.743257

DOI=10.3389/fcvm.2021.743257

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Permanent pacemaker (PPM) implantation is the main complication of transcatheter aortic valve replacement (TAVR). Few studies have evaluated the requirement for PPM implantation due to ECG changes following TAVR in a Chinese population.</p><p><bold>Objective:</bold> Our study aimed to evaluate the incidence and predictors of PPM implantation in a cohort of Chinese patients with TAVR.</p><p><bold>Methods:</bold> We retrospectively evaluated 39 consecutive patients with severe native aortic stenosis referred for TAVR with a self-expandable prosthesis, the Venus A valve (Venus MedTech Inc., Hangzhou, China), from 2019 to 2021 at the Heart Center of Affiliated Zhongshan Hospital of Dalian University. Predictors of PPM implantation were identified using logistic regression.</p><p><bold>Results:</bold> In our study, the incidence of PPM implantation was 20.5%. PPM implantation occurs with higher risk in patients with negative creatinine clearance (CrCl), dyslipidemia, high Society of Thoracic Surgeons (STS) Morbimortality scores, and lead I T wave elevation. TAVR induced several cardiac electrical changes such as increased R wave and T wave changes in lead V5. The main independent predictors of PPM implantation were new-onset left bundle branch block (LBBB) (coef: 3.211, 95% CI: 0.899–7.467, <italic>p</italic> = 0.004) and lead I T wave elevation (coef: 11.081, 95% CI: 1.632–28.083, <italic>p</italic> = 0.016).</p><p><bold>Conclusion:</bold> New-onset LBBB and lead I T wave elevation were the main independent predictors of PPM implantation in patients undergoing TAVR. Clinical indications such as negative CrCl, dyslipidemia, high STS Morbimortality scores, and an increased T wave elevation before TAVR should be treated with caution to decrease the need for subsequent PPM implantation.</p>