Predictors of ventricular pacing burden after permanent pacemaker implantation following transcatheter aortic valve replacement

BACKGROUND: In the era of an expanding use of transcatheter aortic valve replacement (TAVR), conduction disturbances and the requirement for permanent pacemaker (PPM) implantation remains a clinical concern. HYPOTHESIS: Using a single‐center experience, we sought to identify predictors of ventricular pacing burden after TAVR in patients who required PPM implantation. METHODS: We conducted a retrospective study of 359 consecutive patients with symptomatic severe aortic valve stenosis who underwent TAVR at our institution between September 2013 and July 2019. Thirty patients (8.4%) required a PPM within 30 days after TAVR. Pre and post‐TAVR electrocardiograms, pre‐TAVR echocardiograms and computed tomography (CT), TAVR procedural details and post‐TAVR device interrogation records at 1, 3, and 6 months were reviewed. RESULTS: Mean percentage of ventricular pacing (VP%) at 1, 3, and 6 months was 58%, 59%, and 56% respectively. Using univariate logistic regression analysis, patients who had low VP% < 5% at 6 months were more likely to have a prosthesis/echocardiography‐derived left ventricular outflow tract (LVOT) diameter ratio < 1.3 (OR 7.00, P‐value .048), prosthesis/CT‐derived aortic annulus diameter ratio < 1.02 (OR 7.11, P‐value .047), post‐TAVR new‐onset LBBB (OR 16.80, P‐value .019), time to PPM implantation greater than 2 days post‐TAVR (OR 9.38, P‐value .026) and pre‐TAVR use of a beta blocker (OR 9.40, P‐value .026). CONCLUSIONS: In patients who required a PPM implantation post‐TAVR, a lower TAVR prosthesis/LVOT or aortic annulus diameter ratio, post‐TAVR new‐onset LBBB and later time of PPM implantation showed a trend toward predicting a low VP% at 6 months.