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Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2024; 16(2): 49-53
Published online Feb 26, 2024. doi: 10.4330/wjc.v16.i2.49
Risk of permanent pacemaker implantation following transcatheter aortic valve replacement: Which factors are most relevant?
Akash Batta, Juniali Hatwal
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
Author contributions: Batta A and Hatwal J contributed equally to this work.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akash Batta, Doctor, FACC, MBBS, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Received: October 28, 2023
Peer-review started: October 28, 2023
First decision: December 29, 2023
Revised: December 30, 2023
Accepted: January 11, 2024
Article in press: January 11, 2024
Published online: February 26, 2024
Processing time: 115 Days and 12.4 Hours
Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement. The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients. However, this is not without challenges. Need for permanent pacemaker (PPM) post-TAVR remains the most frequent and clinically relevant challenge. Naturally, identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important. Various demographic factors, electrocardiographic features, anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR. Amongst these electrophysiological variables, most notably a prolonged QRS > 120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models. The index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS > 120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.

Keywords: Transcatheter aortic valve replacement; Permanent pacemaker; Diabetes mellitus; QRS duration; Electrophysiological variables

Core Tip: Transcatheter aortic valve replacement (TAVR) has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement. Despite the progress in technology, the improved valve-design and delivery systems, and the improvement in clinical skill and deployment techniques, permanent pacemaker (PPM) implantation remains a major cause of concern post-TAVR. Naturally, identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is relevant. In the index study by Nwaedozie et al, a baseline QRS > 120 ms and the presence of diabetes mellitus were strongest predictors of PPM need post-TAVR.