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.