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Barrett CD, Nickel A, Rosenberg MA, Ream K, Tzou WS, Aleong R, Tumolo A, Garg L, Zipse M, West JJ, Varosy P, Sandhu A. PRIME score for prediction of permanent pacemaker implantation after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 102:1357-1363. [PMID: 37735946 DOI: 10.1002/ccd.30845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/02/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES We sought to produce a simple scoring system that can be applied at clinical visits before transcatheter aortic valve replacement (TAVR) to stratify the risk of permanent pacemaker (PPM) after the procedure. BACKGROUND Atrioventricular block is a known complication of TAVR. Current models for predicting the risk of PPM after TAVR are not designed to be applied clinically to assist with preprocedural planning. METHODS Patients undergoing TAVR at the University of Colorado were split into a training cohort for the development of a predictive model, and a testing cohort for model validation. Stepwise and binary logistic regressions were performed on the training cohort to produce a predictive model. Beta coefficients from the binary logistic regression were used to create a simple scoring system for predicting the need for PPM implantation. Scores were then applied to the validation cohort to assess predictive accuracy. RESULTS Patients undergoing TAVR from 2013 to 2019 were analyzed: with 483 included in the training cohort and 123 included in the validation cohort. The need for a pacemaker was associated with five preprocedure variables in the training cohort: PR interval > 200 ms, Right bundle branch block, valve-In-valve procedure, prior Myocardial infarction, and self-Expandable valve. The PRIME score was developed using these clinical features, and was highly accurate for predicting PPM in both the training and model validation cohorts (area under the curve 0.804 and 0.830 in the model training and validation cohorts, respectively). CONCLUSIONS The PRIME score is a simple and accurate preprocedural tool for predicting the need for PPM implantation after TAVR.
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Affiliation(s)
| | - Andrew Nickel
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | | | - Karen Ream
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Wendy S Tzou
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Ryan Aleong
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Alexis Tumolo
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Lohit Garg
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Matthew Zipse
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - John J West
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Paul Varosy
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Amneet Sandhu
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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See C, Wang Y, Huang H, Parise H, Yang Y, Tirziu D, Francese DP, Papoutsidakis N, Bader E, Kaple RK, Cleman M, Lansky AJ, Forrest JK. Impact of New-Onset Conduction Disturbances following Transcatheter Aortic Valve Replacement on Outcomes: A Single-Center Study. J Interv Cardiol 2023; 2023:5390338. [PMID: 37292113 PMCID: PMC10247319 DOI: 10.1155/2023/5390338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is known to increase the incidence of conduction disturbances compared to surgical aortic valve replacement; however, there are limited data on the impact and duration of these conduction disturbances on longer term outcomes. Objective To determine the differential impact of persistent versus nonpersistent new-onset conduction disturbances on TAVR-related complications and outcomes. Methods This is a single-center retrospective analysis of 927 consecutive patients with aortic stenosis who underwent TAVR at Yale New Haven Hospital from July 2012 to August 2019. Patients with new-onset conduction disturbances within 7 days following TAVR were selected for this study. Persistent and nonpersistent disturbances were, respectively, defined as persisting or not persisting on all patient ECGs for up to 1.5 years after TAVR or until death. Results Within 7 days after TAVR, conduction disturbances occurred in 42.3% (392/927) of the patients. Conduction disturbances persisted in 150 (38%) patients and did not persist in 187 (48%) patients, and 55 (14%) patients were excluded for having mixed (both persistent and nonpersistent) disturbances. Compared with nonpersistent disturbances, patients with persistent disturbances were more likely to receive a PPM within 7 days after the TAVR procedure (46.0% versus 4.3%, p < 0.001) and had a greater unadjusted 1-year cardiac-related and all-cause mortality risk (HR 2.54, p=0.044 and HR 1.90, p=0.046, respectively). Conclusion Persistent conduction disturbances were associated with a greater cardiac and all-cause mortality rate at one year following TAVR. Future research should investigate periprocedural factors to reduce persistent conduction disturbances and outcomes beyond one year follow-up.
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Affiliation(s)
- Claudia See
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanting Wang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Haocheng Huang
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Helen Parise
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Yiping Yang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Daniela Tirziu
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dominic P. Francese
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nikolaos Papoutsidakis
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric Bader
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ryan K. Kaple
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Michael Cleman
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alexandra J. Lansky
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Barts Heart Centre, London and Queen Mary University of London, London, UK
| | - John K. Forrest
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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Koch T, Brunner S, Moccetti F, Wolfrum M, Toggweiler S. Basal Septal Bulge as Risk Factor for New Conduction Disorders After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023:S1936-8798(23)00813-0. [PMID: 37294223 DOI: 10.1016/j.jcin.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
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