Preprocedural CT and ECG Markers for Predicting Post-TAVR Pacemaker Requirement in High-Risk Patients

作者：Justin T. Tretter, Mackram F. Eleid, Francesco Bedogni, Josep Rodés‐Cabau, Ander Regueiro, Luca Testa, Shmuel Chen, Attílio Galhardo, Kenneth A. Ellenbogen, Martin B. Leon, Shlomo A. Ben‐Haim · 发表于：Structural Heart · 年份：2025 · DOI：10.1016/j.shj.2025.100726 · 被引用次数：3 · 研究领域：Cardiac Valve Diseases and Treatments、Aortic Disease and Treatment Approaches、Cardiovascular Function and Risk Factors

Background: Need for permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR) remains a common complication. We aimed to assess computed tomography (CT)-based anatomical and electrocardiogram (ECG)-based parameters in a predictive model for PPI following TAVR. Methods: We assessed CT-based parameters, including the predicted course of the conduction axis from atrioventricular node to left bundle branch origin relative to the aortic virtual basal ring. Electrophysiological variables were combined in assessing a model to predict post-TAVR PPI. Results: Among 433 patients (mean age 82.0 [9.0] years, 54.0% female), 90 (21.0%) required PPI. Multiple binary logistic modeling demonstrated a shallower position of the membranous septum inferior margin midpoint increased the odds of PPI by 20% for every 1 mm (adjusted odds ratio [aOR]: 1.20) adjusted for the CT assessment phase. Increasing aortic root rotational angle associated with lower PPI odds (odds ratio [OR]: 0.98; 95% CI [0.95-1.00]), while an angle between the membranous septum midpoint and noncoronary leaflet nadir associated with increased PPI odds (OR: 1.04; 95% CI [1.01-1.08]). Preprocedural right bundle branch block and first-degree atrioventricular block associated with increased odds for PPI (OR: 3.76; 95% CI [1.71-8.21]; and OR: 1.84; 95% CI [1.06-3.18], respectively). The model had an area under the curve of 0.73 (95% CI [0.67-0.79]), sensitivity of 0.74 (95% CI [0.47-0.93]), and ...