(Permanent pacemaker implantation in patients undergoing TAVR - single center study between years 2009 and 2021)

Aim: To present our data of a prevalence of this complication from one Czech center where TAVR prostheses have been implanted for over a decade. Methods: A group of patients who underwent TAVR between August 2009 and February 2021 in our center were analyzed. Patients with already implanted pacemaker or defibrillator were excluded from this group, leaving 717 patients for further analysis. The mean age was 78.8 years, 52% were females, the mean BMI was 29.6. Various different prostheses of different manufacturers and generations were implanted. Results: Permanent pacing was required in 162 patients (22.6%), in whom CIED (cardiac implantable electronic device) was implanted in average 3.9 days from TAVR. There was a significantly higher amount of men in the paced group (56.2%) compared to the group without CIED (45.4%); p = 0.016. Moreover, there was a significant difference between height, weight, and BSA among these groups. Patients with preexisting right bundle branch block (RBBB) were more prevalent in the paced group compared to non-paced group (p <0.0001); this parameter was the only independent predictor of the implantation of CIED after TAVR (odds ratio 3.8, 95% CI 2.0-7.0; p <0.0001). There were marked differences between the amounts of implanted prostheses of various designs. No significant difference was found in the size of prostheses, predilatation or postdilatation between the two groups of patients. Conclusion: Our data are in concordance with other published studies, supporting the RBBB being one of the risk factors for pacing after TAVR. Males and patients with higher BSA were more prevalent in the paced group. Our sample is, however, rather inhomogeneous and further analysis of different designs in higher numbers would be necessary to identify other risk factors of this prevalent complication.