Prajapathi S, Pradhan A. Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on! World J Cardiol 2024; 16(3): 104-108 [PMID: 38576520 DOI: 10.4330/wjc.v16.i3.104]
Corresponding Author of This Article
Akshyaya Pradhan, FACC, FESC, FSCAI, FAPSIC, MBBS, MD, Professor, Department of Cardiology, King George's Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Mar 26, 2024; 16(3): 104-108 Published online Mar 26, 2024. doi: 10.4330/wjc.v16.i3.104
Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!
Sudesh Prajapathi, Akshyaya Pradhan
Sudesh Prajapathi, Akshyaya Pradhan, Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Pradhan A devised the concept and performed the literature search; Prajapathi S prepared the first draft, and Pradhan A critically reviewed the draft; Prajapathi S prepared the final manuscript, and Pradhan A submitted it.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akshyaya Pradhan, FACC, FESC, FSCAI, FAPSIC, MBBS, MD, Professor, Department of Cardiology, King George's Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Received: November 21, 2023 Peer-review started: November 21, 2023 First decision: December 29, 2023 Revised: January 12, 2024 Accepted: February 18, 2024 Article in press: February 18, 2024 Published online: March 26, 2024
Abstract
Several anatomical, demographic, clinical, electrocardiographic, procedural, and valve-related variables can be used to predict the probability of developing conduction abnormalities after transcatheter aortic valve replacement (TAVR) that necessitate permanent pacemaker (PPM) implantation. These variables include calcifications around the device landing zone and in the mitral annulus; pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks (BBB), first- and second-degree atrioventricular blocks, as well as bifascicular and trifascicular blocks; male sex; diabetes mellitus (DM); hypertension; history of atrial fibrillation; renal failure; dementia; and use of self-expanding valves. The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR. Regardless of the side of the BBB, this study demonstrated, for the first time, a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration (above 100 ms). After a 1-year follow-up, patients who received PPM post-TAVR had a higher rate of hospitalization for heart failure and nonfatal myocardial infarction.
Core Tip: Several anatomical, demographic, clinical, electrocardiographic, procedural, and valve-related variables predict the probability of developing conduction abnormalities after transcatheter aortic valve replacement (TAVR) that necessitate permanent pacemaker placement. The current study reinforces the existing literature by demonstrating that type 2 diabetes mellitus and baseline right bundle branch block are significant predictors of pacemaker implantation post-TAVR. The study investigators also revealed a novel linear relationship between the post-TAVR incidence of pacemaker implantation with every 20 ms increase in baseline QRS duration. Interestingly, pacemaker implantation following TAVR was predictive of future cardiovascular events at 1 year.
