Janiszewski Alexandra, Lueg Julia, Schulze Daniel, Juri Benjamin, Morell Louis, Hajduczenia Maria, Hennig Pierre, Erbay Aslihan, Lembcke Alexander, Niehues Stefan, Landmesser Ulf, Stangl Karl, Leistner David, Tscholl Verena, Dreger Henryk
Department of Cardiology, Angiology and Intensive Care Medicine Deutsches Herzzentrum der Charité Berlin Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Germany.
J Am Heart Assoc. 2025 May 20;14(10):e039036. doi: 10.1161/JAHA.124.039036. Epub 2025 May 15.
The need for postoperative permanent pacemaker implantation (PPMI) remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). This study aimed to develop a novel, 2-step risk score to predict PPMI probability after TAVI and implement it into a user-friendly website. Our risk score addresses the data gap on current prosthesis generations and provides a new, clinically motivated approach to calculating PPMI risk.
Between January 2019 and December 2020, 1039 patients underwent TAVI at our institution. We retrospectively evaluated clinical, electrocardiographic, echocardiographic, computed tomographic, and periprocedural data. Patients with prior PPMI were excluded. We developed a prediction model for PPMI occurrence, using 55 patient and procedural characteristics. With exclusion criteria applied, 836 patients (mean age 80.3±9.1 years; 50.6% female) were included. Of these, 149 (17.8%) required PPMI within 30 days after TAVI. Fourteen preprocedural parameters, including preexisting right bundle-branch block, atrioventricular block, left bundle-branch block, bradycardia, interventricular septum thickness, New York Heart Association class, and aortic annulus perimeter, were identified as PPMI risk factors and used to calculate the baseline risk in the first step of the TAVI PACER score. The second step includes intraprocedural variables to demonstrate how PPMI risk can vary based on valve type and implantation depth. The TAVI PACER score predicts PPMI with a sensitivity of 76% and specificity of 72% (area under the curve=0.8).
The TAVI PACER score provides a novel tool for daily clinical practice, predicting individual PPMI risk after TAVI based on various patient and procedural characteristics.
术后永久性起搏器植入（PPMI）的需求仍然是经导管主动脉瓣植入术（TAVI）后最常见的并发症之一。本研究旨在开发一种新颖的两步风险评分，以预测TAVI后PPMI的概率，并将其应用于一个用户友好的网站。我们的风险评分解决了当前假体一代的数据缺口，并提供了一种新的、基于临床动机的方法来计算PPMI风险。
2019年1月至2020年12月期间，1039例患者在我们机构接受了TAVI。我们回顾性评估了临床、心电图、超声心动图、计算机断层扫描和围手术期数据。排除既往有PPMI的患者。我们使用55个患者和手术特征开发了一个PPMI发生的预测模型。应用排除标准后，纳入了836例患者（平均年龄80.3±9.1岁；50.6%为女性）。其中，149例（17.8%）在TAVI后30天内需要PPMI。14个术前参数，包括既往右束支传导阻滞、房室传导阻滞、左束支传导阻滞、心动过缓、室间隔厚度、纽约心脏协会分级和主动脉瓣环周长，被确定为PPMI风险因素，并用于计算TAVI PACER评分第一步的基线风险。第二步包括术中变量，以证明PPMI风险如何根据瓣膜类型和植入深度而变化。TAVI PACER评分预测PPMI的敏感性为76%，特异性为72%（曲线下面积=0.8）。
TAVI PACER评分为日常临床实践提供了一种新颖的工具，可根据各种患者和手术特征预测TAVI后个体的PPMI风险。
