title: Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: insights from a Brazilian registry.
abstract: 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.
  
  
  CONCLUSIONS
  PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, 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.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Gensas
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: adriano.caixeta@einstein.br.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Dimytri
authors.initials: D
authors.lastname: Siqueira
authors.affiliation: Hospital Pró-Cardíaco, Rio de Janeiro, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Carvalho
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Sarmento-Leite
authors.affiliation: Hospital Beneficiência Portuguesa, São Paulo, Brazil.
authors.forename: José A
authors.initials: JA
authors.lastname: Mangione
authors.affiliation: Instituto do Coração da FMUSP, São Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Instituto de Cardiologia Laranjeiras, Rio de Janeiro, Brazil.
authors.forename: Alexandre S
authors.initials: AS
authors.lastname: Colafranceschi
authors.affiliation: Hospital São Lucas da PUC, Porto Alegre, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Caramori
authors.affiliation: Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Ferreira
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Fábio S
authors.initials: FS
authors.lastname: Brito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000639:trends*; D011237:Predictive Value of Tests; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000639:trends*
keywords: Pacemaker; Transcatheter aortic valve implantation; Transcatheter aortic valve implantation complications