Predictors of Permanent Pacemaker Insertion after TAVR: A Systematic
Review and Updated Meta-Analysis
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.