Incidence and Predictors of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Two-centre experience from Oman

TL;DR

This study from Oman finds that about 10% of patients need a pacemaker after a heart valve procedure called TAVR, with certain heart rhythm issues increasing the risk.

Contribution

The study identifies specific pre-existing heart rhythm predictors for pacemaker implantation after TAVR in an Omani population.

Findings

9.8% of TAVR patients required a permanent pacemaker within one year.

Pre-existing right bundle branch block was the strongest predictor of pacemaker need.

Other predictors included abnormal QRS axis and prolonged QRS duration.

Abstract

This study aims to evaluate the predictors and rate of permanent pacemaker (PPM) implantation among patients undergoing transcatheter aortic valve replacement (TAVR) at two institutions in Oman. TAVR has become the standard of care for patients with severe aortic stenosis at high risk for surgery. However, it is associated with a high PPM implantation rate.

This was a retrospective study involving all patients undergoing TAVR at two leading cardiac centres in Oman over seven years, from May 2013 to September 2020. We included patients who survived the procedure to discharge and those who were followed-up for at least 1 year post-procedure.

A total of 153 patients (mean age = 74.2 ± 8.2 years; 82 males [53.6%]) were enrolled in the study. Of these, 15 patients (age = 74.3 ± 9.8 years, 46.6% male) required a permanent pacemaker within 1 year of follow-up, giving a pacemaker implantation rate of 9.8% following TAVR in the cohort. The factors that predicted the requirement of a pacemaker were pre-existing right bundle branch block (odds ratio [OR] = 10.9, 95% confidence interval [CI]: 3.31–36.33; P < 0.001); abnormal QRS axis (OR = 9.11, 95% CI: 2.77–29.91; P < 0.001); prolonged QRS duration (OR = 3.26, 95% CI: 1.06–9.92; P = 0.03); and any pre-existing conduction abnormality (OR = 1.18, 95% CI: 1.08–1.29; P = 0.01).

The PPM implantation rates post-TAVR at two Omani institutions are comparable to those reported in the literature. Close rhythm surveillance is crucial, especially in patients with any of the predictors identified above, for the timely identification of susceptible patients who might require PPM implantation.

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