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- Title
Predictors of permanent pacemaker insertion after TAVR: A systematic review and updated meta‐analysis.
- Authors
Mahajan, Sugandhi; Gupta, Rahul; Malik, Aaqib H.; Mahajan, Pranav; Aedma, Surya K.; Aronow, Wilbert S.; Mehta, Sanjay S.; Lakkireddy, Dhanunjaya R.
- Abstract
Objectives: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). Background: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications. Methods: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random‐effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results: Thirty‐seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self‐expandable valve over balloon‐expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation. Conclusion: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high‐risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
- Subjects
SURGICAL complication risk factors; PROSTHETICS; HEART valve prosthesis implantation; META-analysis; CONFIDENCE intervals; SYSTEMATIC reviews; AGE distribution; BUNDLE-branch block; AORTIC stenosis; SURGICAL complications; SURGERY; PATIENTS; DIABETES; CORONARY disease; SEVERITY of illness index; HEART block; RISK assessment; SEX distribution; DESCRIPTIVE statistics; PROSTHETIC heart valves; CARDIAC pacemakers; STATISTICAL models; ODDS ratio; CALCIUM; CATHETERIZATION; DISEASE risk factors
- Publication
Journal of Cardiovascular Electrophysiology, 2021, Vol 32, Issue 5, p1411
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.14986