Risk Prediction Model for Cardiac Implantable Electronic Device
Implantation After Transcatheter Aortic Valve Replacement in Patients
with Pre-Existing Atrial Fibrillation
Abstract
Introduction High-grade atrioventricular block (AVB) requiring cardiac
implantable electronic device (CIED) following transcatheter aortic
valve replacement (TAVR) is an important post-procedural complication.
Risk prediction models have been developed to identify patients in sinus
rhythm at risk for CIED placement following TAVR. Atrial fibrillation
(AF) is frequently present in patients referred for TAVR and no risk
prediction model has been developed for these patients. This study was
undertaken to assess the accuracy of utilizing a previously validated
risk prediction model in patients with pre-existing atrial fibrillation
(1). Methods and Results This single center, retrospective study
analyzed patients with pre-existing AF who underwent TAVR from July 2015
to November 2019. A summative risk prediction score was calculated using
a previously described risk prediction model based on the use of a
self-expanding valve (1 point), hypertension (1 point), and right bundle
branch block on baseline electrocardiogram (2 points), and omitting
pre-existing first degree AVB. The model demonstrated good predictive
accuracy with an ideal linear regression in calibration plot (R2 =
0.778) and AUC in ROC of 0.652 (95% confidence interval 0.558 –
0.745). Conclusions Our previously validated risk prediction model
accurately predicts the risk of post-TAVR CIED implantation in patients
with pre-existing AF.