Predictors of pacemaker implantation after transcatheter aortic valve implantation according to kind of prosthesis and risk profile: A systematic review and contemporary meta-Analysis

Francesco Bruno*, Fabrizio D'Ascenzo, Matteo Pio Vaira, Edoardo Elia, Pierluigi Omedè, Susheel Kodali, Marco Barbanti, Josep Rodès-Cabau, Oliver Husser, Samuel Sossalla, Nicolas M. Van Mieghem, Jeroen Bax, David Hildick-Smith, Antonio Munoz-Garcia, Francesco Pollari, Theodor Fischlein, Carlo Budano, Antonio Montefusco, Guglielmo Gallone, Ovidio De FilippoMauro Rinaldi, Michele La Torre, Stefano Salizzoni, Francesco Atzeni, Marco Pocar, Federico Conrotto, Gaetano Maria De Ferrari

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

8 Citations (Scopus)

Abstract

Aims: Permanent pacemaker implantation (PPI) may be required after transcatheter aortic valve implantation (TAVI). Evidence on PPI prediction has largely been gathered from high-risk patients receiving first-generation valve implants. We undertook a meta-Analysis of the existing literature to examine the incidence and predictors of PPI after TAVI according to generation of valve, valve type, and surgical risk. Methods and results: We made a systematic literature search for studies with ≥100 patients reporting the incidence and adjusted predictors of PPI after TAVI. Subgroup analyses examined these features according to generation of valve, specific valve type, and surgical risk. We obtained data from 43 studies, encompassing 29 113 patients. Permanent pacemaker implantation rates ranged from 6.7% to 39.2% in individual studies with a pooled incidence of 19% (95% CI 16-21). Independent predictors for PPI were age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09], left bundle branch block (LBBB) (OR 1.45, 95% CI 1.12-1.77), right bundle branch block (RBBB) (OR 4.15, 95% CI 3.23-4.88), implantation depth (OR 1.18, 95% CI 1.11-1.26), and self-expanding valve prosthesis (OR 2.99, 95% CI 1.39-4.59). Among subgroups analysed according to valve type, valve generation and surgical risk, independent predictors were RBBB, self-expanding valve type, first-degree atrioventricular block, and implantation depth. Conclusions: The principle independent predictors for PPI following TAVI are age, RBBB, LBBB, self-expanding valve type, and valve implantation depth. These characteristics should be taken into account in pre-procedural assessment to reduce PPI rates. PROSPERO ID CRD42020164043.

Original languageEnglish
Pages (from-to)143-153
Number of pages11
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume7
Issue number2
DOIs
Publication statusPublished - 2021

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