Title: C-46 | Novel Predictors and Clinical Outcomes of Permanent Pacemaker Placement (PPM) Following Transcatheter Aortic Valve Replacement (TAVR): A Midwest Rural Center Experience
Abstract: BackgroundConduction and rhythm abnormalities requiring PPM are few of the complications following TAVR, and their clinical outcomes remain unclear. The potential clinical value of novel predictors of post-TAVR PPM, such as the presence of supraventricular arrhythmias, QRS duration, and duration of QTc is unclear.MethodsA retrospective cohort study of patients with TAVR (January 2012-December 2019) was performed. The group was dichotomized into those requiring PPM and those without PPM placement. Both groups were followed for one year.ResultsA total of 357 patients with TAVR were included. The mean age was 80 years, 188 (52.7%) were male and 57 [16%] required a PPM. Baseline demographics, valve type, and cardiovascular risk factors were similar between groups. However Diabetes Mellitus type II (DMII) was more prevalent in the PPM cohort [59.6% vs 40.7%; P= 0.009]. The PPM cohort had also a significantly higher rate of pre-procedure RBBB but not LBBB, prolonged QRS > 120 ms, prolonged QTc > 470 ms, and supraventricular arrhythmias. The PPM cohort had also a higher adjusted odds ratio of heart failure hospitalization (aOR 2.2; CI; 1.1-4.3; P=0.022), and myocardial infarction (aOR 3.9; CI; 1.1-14; P=0.031) without difference in mortality at one year.The necessity for PPM placement was associated with a progressive widening of the QRS, which was demonstrated by the continuous increase in the odds ratio (OR) for every 20ms increase in the QRS duration above 100ms: QRS 101-120 [OR 2.44; CI; 1.14-5.25; P=0.022], QRS 121-140 [OR 3.25; CI; 1.32-7.98; P=0.010], QRS 141-160 [OR 6.98; CI; 3.10-15.61; P<0.001]. After adjustments the final model demonstrated that the odds ratio remained significant for DMII, [2.16; CI; 1.18-3.94; P=0.012), QRS>120 [2.18; CI; 1.02-4.66; P=0.045], and marginally significant for supraventricular arrhythmias [1.82; CI; 0.97-3.42; P=0.062].ConclusionsPre- TAVR DMII and QRS>120 ms are strong predictors of post TAVR PPM. Progressive widening of the QRS beyond 100 ms is associated with the increased need for post TAVR PPM. At 1-year post TAVR, patients with PPM have higher odds of heart failure hospitalization and myocardial infarction.DisclosuresS. Nwaedozie Nothing to disclose. P. Sharma Nothing to disclose. P. Yeung Nothing to disclose. P. Umukoro Nothing to disclose. D. Soodi Nothing to disclose. J. Najjar Mojarrab Nothing to disclose. H. Zhang Nothing to disclose. R. Gabor Nothing to disclose. R. Garcia-Montilla Nothing to disclose. BackgroundConduction and rhythm abnormalities requiring PPM are few of the complications following TAVR, and their clinical outcomes remain unclear. The potential clinical value of novel predictors of post-TAVR PPM, such as the presence of supraventricular arrhythmias, QRS duration, and duration of QTc is unclear. Conduction and rhythm abnormalities requiring PPM are few of the complications following TAVR, and their clinical outcomes remain unclear. The potential clinical value of novel predictors of post-TAVR PPM, such as the presence of supraventricular arrhythmias, QRS duration, and duration of QTc is unclear. MethodsA retrospective cohort study of patients with TAVR (January 2012-December 2019) was performed. The group was dichotomized into those requiring PPM and those without PPM placement. Both groups were followed for one year. A retrospective cohort study of patients with TAVR (January 2012-December 2019) was performed. The group was dichotomized into those requiring PPM and those without PPM placement. Both groups were followed for one year. ResultsA total of 357 patients with TAVR were included. The mean age was 80 years, 188 (52.7%) were male and 57 [16%] required a PPM. Baseline demographics, valve type, and cardiovascular risk factors were similar between groups. However Diabetes Mellitus type II (DMII) was more prevalent in the PPM cohort [59.6% vs 40.7%; P= 0.009]. The PPM cohort had also a significantly higher rate of pre-procedure RBBB but not LBBB, prolonged QRS > 120 ms, prolonged QTc > 470 ms, and supraventricular arrhythmias. The PPM cohort had also a higher adjusted odds ratio of heart failure hospitalization (aOR 2.2; CI; 1.1-4.3; P=0.022), and myocardial infarction (aOR 3.9; CI; 1.1-14; P=0.031) without difference in mortality at one year.The necessity for PPM placement was associated with a progressive widening of the QRS, which was demonstrated by the continuous increase in the odds ratio (OR) for every 20ms increase in the QRS duration above 100ms: QRS 101-120 [OR 2.44; CI; 1.14-5.25; P=0.022], QRS 121-140 [OR 3.25; CI; 1.32-7.98; P=0.010], QRS 141-160 [OR 6.98; CI; 3.10-15.61; P<0.001]. After adjustments the final model demonstrated that the odds ratio remained significant for DMII, [2.16; CI; 1.18-3.94; P=0.012), QRS>120 [2.18; CI; 1.02-4.66; P=0.045], and marginally significant for supraventricular arrhythmias [1.82; CI; 0.97-3.42; P=0.062]. A total of 357 patients with TAVR were included. The mean age was 80 years, 188 (52.7%) were male and 57 [16%] required a PPM. Baseline demographics, valve type, and cardiovascular risk factors were similar between groups. However Diabetes Mellitus type II (DMII) was more prevalent in the PPM cohort [59.6% vs 40.7%; P= 0.009]. The PPM cohort had also a significantly higher rate of pre-procedure RBBB but not LBBB, prolonged QRS > 120 ms, prolonged QTc > 470 ms, and supraventricular arrhythmias. The PPM cohort had also a higher adjusted odds ratio of heart failure hospitalization (aOR 2.2; CI; 1.1-4.3; P=0.022), and myocardial infarction (aOR 3.9; CI; 1.1-14; P=0.031) without difference in mortality at one year. The necessity for PPM placement was associated with a progressive widening of the QRS, which was demonstrated by the continuous increase in the odds ratio (OR) for every 20ms increase in the QRS duration above 100ms: QRS 101-120 [OR 2.44; CI; 1.14-5.25; P=0.022], QRS 121-140 [OR 3.25; CI; 1.32-7.98; P=0.010], QRS 141-160 [OR 6.98; CI; 3.10-15.61; P<0.001]. After adjustments the final model demonstrated that the odds ratio remained significant for DMII, [2.16; CI; 1.18-3.94; P=0.012), QRS>120 [2.18; CI; 1.02-4.66; P=0.045], and marginally significant for supraventricular arrhythmias [1.82; CI; 0.97-3.42; P=0.062]. ConclusionsPre- TAVR DMII and QRS>120 ms are strong predictors of post TAVR PPM. Progressive widening of the QRS beyond 100 ms is associated with the increased need for post TAVR PPM. At 1-year post TAVR, patients with PPM have higher odds of heart failure hospitalization and myocardial infarction. Pre- TAVR DMII and QRS>120 ms are strong predictors of post TAVR PPM. Progressive widening of the QRS beyond 100 ms is associated with the increased need for post TAVR PPM. At 1-year post TAVR, patients with PPM have higher odds of heart failure hospitalization and myocardial infarction.