Author + information
- Received May 14, 2019
- Revision received July 5, 2019
- Accepted July 11, 2019
- Published online November 4, 2019.
- Soroosh Kiani, MDa,∗ (, )@rooshK_EP,
- Norihiko Kamioka, MDa,
- George B. Black, MDa,
- Marvin Louis Roy Lu, MDa,
- John C. Lisko, MDa,
- Birju Rao, MDb,
- Andenet Mengistu, BSa,
- Patrick T. Gleason, MDa,
- James P. Stewart, BSa,
- Hope Caughron, MDb,
- Andy Dong, BSb,
- Hima Patel, BSb,
- Kendra J. Grubb, MDc,
- Adam B. Greenbaum, MDa,
- Chandan M. Devireddy, MDa,
- Robert A. Guyton, MDc,
- Bradley Leshnower, MDc,
- Faisal M. Merchant, MDa,
- Mikhael El-Chami, MDa,
- Stacy B. Westerman, MDa,
- Michael S. Lloyd, MDa,
- Vasilis C. Babaliaros, MDa and
- Michael H. Hoskins, MDa
- aDepartment of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- bDepartment of Medicine, Emory University School of Medicine, Atlanta, Georgia
- cDepartment of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Soroosh Kiani, Emory University School of Medicine, 101 Woodruff Circle, WMB 1013, Atlanta, Georgia 30322.
Objectives The aim of this study was to define risk factors and develop a predictive risk score for new pacemaker implantation (PMI) after transcatheter aortic valve replacement (TAVR).
Background TAVR has become an accepted treatment alternative for patients with severe aortic stenosis at elevated surgical risk. New PMI is a common occurrence after TAVR and is associated with poorer outcomes.
Methods All patients without prior valve procedures undergoing elective TAVR with the Edwards SAPIEN 3 at a single institution (n = 1,266) were evaluated. Multivariate analysis was performed to evaluate for predictors of PMI in this population in a derivation cohort of patients with complete data (n = 778), and this model was used to develop the Emory risk score (ERS), which was tested in a validation cohort (n = 367).
Results Fifty-seven patients (7.3%) in the derivation cohort required PMI. In a regression model, history of syncope (odds ratio [OR]: 2.5; p = 0.026), baseline right bundle branch block (OR: 4.3; p < 0.001), QRS duration ≥138 ms (OR: 2.5; p = 0.017), and valve oversizing >15.6% (OR: 1.9; p = 0.041) remained independent predictors of PMI and were included in the ERS. The ERS was strongly associated with PMI (per point increase OR: 2.2; p < 0.001) with an area under the receiver-operating characteristic curve of 0.778 (p < 0.001), which was similar to its performance in the derivation cohort.
Conclusions A history of syncope, right bundle branch block, longer QRS duration, and higher degree of oversizing are predictive of the need for PMI after TAVR. Additionally, the ERS for PMI was developed and validated, representing a simple bedside tool to aid in risk stratification for patients for undergoing TAVR.
Dr. Leshnower is a member of the Speakers Bureau for Medtronic. Dr. Devireddy is a member of the data safety monitoring board of Medtronic; and is a member of the scientific advisory boards of Vascular Dynamics and ReCor Medical. Dr. Babaliaros holds equity in Transmural Systems; and is a consultant for Edwards Lifesciences and Abbott Vascular. Dr. El-Chami is a consultant for Medtronic and Boston Scientific. Dr. Lloyd is a consultant for and received research support from Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 14, 2019.
- Revision received July 5, 2019.
- Accepted July 11, 2019.
- 2019 American College of Cardiology Foundation
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