Jung Susanne, Kondruweit Markus, Marwan Mohamed, Achenbach Stephan
Department of Cardiology Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen Erlangen Germany.
Department of Cardiac Surgery Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen Erlangen Germany.
J Am Heart Assoc. 2025 May 20;14(10):e039020. doi: 10.1161/JAHA.124.039020. Epub 2025 May 15.
High-degree atrioventricular block with the need for permanent pacemaker (PPM) implantation represents a frequent complication after transcatheter aortic valve implantation (TAVI). Extension of indication for TAVI toward subjects with lower surgical risk requires reduction of the likelihood for the need for PPM implantation. The aim of the current analysis was to identify predictors of the need for PPM implantation after TAVI.
In a cohort of 1500 consecutive patients without a PPM undergoing transfemoral TAVI, clinical and procedural characteristics as well as parameters derived from cardiac computed tomography, such as membranous septal length and calcium volumes of the aortic valve cusps and the left ventricular outflow tract were assessed. Median calcium volume of the aortic valve was 552 mm (interquartile range [IQR]: 340-811 mm) in the group of subjects requiring a PPM, which was higher than in the group of subjects not requiring PPM implantation (455 mm [IQR: 245-723 mm], =0.001). The same was true for calcification of the noncoronary cusp (=0.027), left coronary cusp (=0.033), and right coronary cusp (=0.006). In multivariable analysis, calcium volume of the noncoronary cusp (=0.039; odds ratio [OR], 1.089 per 100 mm), preexisting complete right bundle-branch block (<0.001; OR, 9.402), and implantation of a self-expandable prosthesis (<0.001; OR, 1.856) were significantly associated with PPM implantation after TAVI.
The current analysis offers a detailed examination of predictors for the need for PPM implantation after TAVI. Our results may contribute to improved risk stratification on the need for PPM implantation after TAVI.
需要植入永久起搏器（PPM）的高度房室传导阻滞是经导管主动脉瓣植入术（TAVI）后常见的并发症。将TAVI的适应证扩展至手术风险较低的患者需要降低PPM植入的可能性。本分析的目的是确定TAVI后PPM植入需求的预测因素。
在一组1500例连续接受经股动脉TAVI且未植入PPM的患者中，评估了临床和手术特征以及从心脏计算机断层扫描得出的参数，如膜周部长度、主动脉瓣叶和左心室流出道的钙体积。需要PPM的患者组中主动脉瓣的钙体积中位数为552 mm（四分位间距[IQR]：340 - 811 mm），高于不需要植入PPM的患者组（455 mm[IQR：245 - 723 mm]，P = 0.001）。无冠瓣钙化（P = 0.027）、左冠瓣钙化（P = 0.033）和右冠瓣钙化（P = 0.006）情况亦是如此。在多变量分析中，无冠瓣的钙体积（P = 0.039；比值比[OR]，每100 mm为1.089）、既往存在的完全性右束支传导阻滞（P < 0.001；OR，9.402）以及自膨胀式假体植入（P < 0.001；OR，1.856）与TAVI后PPM植入显著相关。
本分析详细研究了TAVI后PPM植入需求的预测因素。我们的结果可能有助于改善TAVI后PPM植入需求的风险分层。
