Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry

Background: The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. Methods: Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. Results: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p = 0.07), have pre-dilation (68.42% vs. 60.07%, p = 0.15), receive CoreValve (93.68% vs. 82.55%, p = 0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p < 0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p = 0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p < 0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p = 0.04) were independent predictors of PPM implantation. Conclusion: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon predilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB. (C) 2014 Elsevier Ireland Ltd. All rights reserved.