Discussion
TAVR is rapidly emerging as a frequently performed and less invasive
treatment alternative to surgical aortic valve replacement. In recent
trials it has shown superior outcomes, even in patients with low
surgical risk (43). However, despite the increase in procedural
expertise, conduction disturbances and pacemaker insertion remain major
complications following TAVR, with incidence reported to be
approximately 7.8% to 20.3% in prior studies (44).
There have been several studies of post-TAVR PPMI looking for various
risk predictors including anatomic, procedural, electrophysiological and
demographic factors. A meta-analysis by Siontis et al (2014) included
studies that identified 20 different predictors using both univariate
and multivariable analysis (45). In our analysis, we included only those
that used a multivariate regression model. Our findings suggest that
age, baseline conduction problems (including RBBB, AVB and LAFB), LVOT
calcium, pre- and post-procedure balloon dilatation, implant depth,
valve size/annulus size and valve type are all linked to increased risk
for PPMI following TAVR.