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Predictors of Permanent Pacemaker Insertion after TAVR: A Systematic Review and Updated Meta-Analysis
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  • SUGANDHI MAHAJAN,
  • Rahul Gupta,
  • Aaqib Malik,
  • Pranav Mahajan,
  • Surya Aedma,
  • Wilbert Aronow,
  • Sanjay Mehta,
  • Dhanunjaya Lakkireddy
SUGANDHI MAHAJAN
Carle Foundation Hospital
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Rahul Gupta
Lehigh Valley Health Network
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Aaqib Malik
Westchester Medical Center Health Network
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Pranav Mahajan
Carle Foundation Hospital
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Surya Aedma
Carle Foundation Hospital
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Wilbert Aronow
Westchester Medical Center
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Sanjay Mehta
Carle Foundation Hospital
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Dhanunjaya Lakkireddy
The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest
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Abstract

Objectives: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following Transcatheter Aortic Valve Replacement (TAVR). Background: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common post-procedural complications. Methods: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results: 37 observational studies with 71,455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and non-coronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, pre-dilatation balloon valvuloplasty and post-implant balloon dilation. Conclusion: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.

Peer review status:UNDER REVIEW

30 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
01 Sep 2020Assigned to Editor
01 Sep 2020Submission Checks Completed
06 Sep 2020Reviewer(s) Assigned