Al Rawahi Mohamed N, Al Kindi Adil, Al Yarubi Ahmed, Shams Ahmed, Al Riyami Adil, Al Lawati Hatim, El Said Ahmed, Al Riyami Mohamed, Al Saidi Khalid, Al Abri Ismail, Al Rawahi Najib, Al Ismaili Abdullah, Al Kindi Fahad, Sadiq Muhammad A, Nadar Sunil K
Department of Medicine, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman.
Department of Surgery, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman.
Sultan Qaboos Univ Med J. 2025 May 2;25(1):209-217. doi: 10.18295/2075-0528.2831.
This study aims to evaluate the predictors and rate of permanent pacemaker (PPM) implantation among patients undergoing transcatheter aortic valve replacement (TAVR) at two institutions in Oman. TAVR has become the standard of care for patients with severe aortic stenosis at high risk for surgery. However, it is associated with a high PPM implantation rate.
This was a retrospective study involving all patients undergoing TAVR at two leading cardiac centres in Oman over seven years, from May 2013 to September 2020. We included patients who survived the procedure to discharge and those who were followed-up for at least 1 year post-procedure.
A total of 153 patients (mean age = 74.2 ± 8.2 years; 82 males [53.6%]) were enrolled in the study. Of these, 15 patients (age = 74.3 ± 9.8 years, 46.6% male) required a permanent pacemaker within 1 year of follow-up, giving a pacemaker implantation rate of 9.8% following TAVR in the cohort. The factors that predicted the requirement of a pacemaker were pre-existing right bundle branch block (odds ratio [OR] = 10.9, 95% confidence interval [CI]: 3.31-36.33; < 0.001); abnormal QRS axis (OR = 9.11, 95% CI: 2.77-29.91; < 0.001); prolonged QRS duration (OR = 3.26, 95% CI: 1.06-9.92; = 0.03); and any pre-existing conduction abnormality (OR = 1.18, 95% CI: 1.08-1.29; = 0.01).
The PPM implantation rates post-TAVR at two Omani institutions are comparable to those reported in the literature. Close rhythm surveillance is crucial, especially in patients with any of the predictors identified above, for the timely identification of susceptible patients who might require PPM implantation.
本研究旨在评估阿曼两家机构中接受经导管主动脉瓣置换术（TAVR）的患者永久性起搏器（PPM）植入的预测因素及植入率。TAVR已成为手术高危的严重主动脉瓣狭窄患者的标准治疗方法。然而，它与较高的PPM植入率相关。
这是一项回顾性研究，纳入了2013年5月至2020年9月期间在阿曼两家主要心脏中心接受TAVR的所有患者。我们纳入了手术存活至出院的患者以及术后至少随访1年的患者。
共有153例患者（平均年龄=74.2±8.2岁；82例男性[53.6%]）纳入研究。其中，15例患者（年龄=74.3±9.8岁，46.6%为男性）在随访1年内需要植入永久性起搏器，该队列中TAVR术后起搏器植入率为9.8%。预测需要起搏器的因素包括既往存在的右束支传导阻滞（比值比[OR]=10.9，95%置信区间[CI]：3.31-36.33；P<0.001）；异常QRS轴（OR=9.11，95%CI：2.77-29.91；P<0.001）；QRS时限延长（OR=3.26，95%CI：1.06-9.92；P=0.03）；以及任何既往存在的传导异常（OR=1.18，95%CI：1.08-1.29；P=0.01）。
阿曼两家机构TAVR术后的PPM植入率与文献报道相当。严密的心律监测至关重要，尤其是对于上述任何一种预测因素的患者，以便及时识别可能需要植入PPM的易感患者。
