title: Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  Determine predictors of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  A retrospective chart review of patients undergoing TAVR at the authors' institution. Extracted data included patient demographics, electrocardiogram, procedural, and echocardiographic data. Multivariate regression was performed to identify associations with PPM implantation.
  
  
  METHODS
  Single-center academic hospital.
  
  
  METHODS
  Patients undergoing TAVR.
  
  
  METHODS
  This study was retrospective. No interventions were performed on patients.
  
  
  RESULTS
  Baseline electrocardiogram, Society of Thoracic Surgeons score, age, and echocardiographic parameters were not predictors of PPM implantation. However, multiple deployments was a risk factor, and degree of paravalvular leak trended toward significance. Ten patients required placement of a 2nd valve, or valve-in-valve (VIV). Of the 10 patients with VIV, 5 (50%) required a PPM, compared with 8 (14%) of 56 patients with a single valve (OR 6.0, p = 0.02). PPM implantation occurred in 5 (42%) patients with no leak, 8 (19%) patients with trace leak, and no patients with mild or moderate leak (p = 0.085). In patients with no or trace leak, VIV increased the likelihood of PPM from 17.4% to 62.5% (OR 7.9, p = 0.006). For the 42 patients with trace leak, VIV increased the likelihood of PPM from 11.4% to 57.1% (OR 10.33, p = 0.005).
  
  
  CONCLUSIONS
  The authors found VIV placement, and likely degree of paravalvular leak, to be predictors of PPM placement. VIV and the degree of leak may be useful markers for postoperative prophylactic pacemaker placement.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: matthew.j.hoyt@hitchcock.org.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hoyt
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hathaway
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Roseanne
authors.initials: R
authors.lastname: Palmer
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Michael
authors.initials: M
authors.lastname: Beach
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: ECG; ECHO; Transcatheter aortic valve replacement; pacemaker; paravalvular leak