Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement

Takahiro Tsushima; Fahd Nadeem; Sadeer Al-Kindi; Joshua R Clevenger; Eric J Bansal; Heather L Wheat; Ankur Kalra; Guilherme F Attizzani; Yakov Elgudin; Alan Markowitz; Marco A Costa; Daniel I Simon; Mauricio S Arruda; Judith A Mackall; Sergio G Thal

doi:10.1016/j.jacep.2019.10.020

Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement

JACC Clin Electrophysiol. 2020 Mar;6(3):295-303. doi: 10.1016/j.jacep.2019.10.020. Epub 2020 Jan 29.

Authors

Affiliations

¹ Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
² Department of Medicine, Division of Cardiology, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
³ Department of Surgery, Division of Cardiac Surgery, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁴ Department of Medicine, Division of Cardiology, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Electronic address: Sergio.Thal@UHhospitals.org.

PMID: 32192680
DOI: 10.1016/j.jacep.2019.10.020

Abstract

Objectives: The aim of this study was to develop and validate a risk prediction model for high-grade atrioventricular block requiring cardiac implantable electronic device (CIED) implantation after transcatheter aortic valve replacement (TAVR).

Background: High-grade atrioventricular block requiring CIED remains a significant sequelae following TAVR. Although several pre-operative characteristics have been associated with the risk of post-operative CIED implantation, an accurate and validated risk prediction model is not established yet.

Methods: This was a single center, retrospective study of consecutive patients who underwent TAVR from March 10, 2011, to October 8, 2018. This cohort sample was randomly divided into a derivation cohort (group A) and a validation cohort (group B). A scoring system for risk prediction of post-TAVR CIED implantation was devised using logistic regression estimates in group A and the calibration and validation were done in group B.

Results: A total of 1,071 patients underwent TAVR during the study period. After excluding pre-existing CIED, a total of 888 cases were analyzed (group A: 507 and group B: 381). Independent predictive variables were as follows: self-expanding valve (1 point), hypertension (1 point), pre-existing first-degree atrioventricular block (1 point), and right bundle branch block (2 points). The resulting score was calculated from the total points. The internal validation in group B showed an ideal linear relationship in calibration plot (R² = 0.933) and a good predictive accuracy (area under the curve: 0.693; 95% confidence interval: 0.627 to 0.759).

Conclusions: This prediction model accurately predicts post-operative risk of CIED implantation with simple pre-operative parameters.

Keywords: atrioventricular block; cardiac implantable electronic device; risk prediction; transcatheter aortic valve replacement.

MeSH terms

Aged
Aged, 80 and over
Atrioventricular Block / surgery*
Cardiac Pacing, Artificial / statistics & numerical data*
Female
Humans
Male
Pacemaker, Artificial / statistics & numerical data*
Retrospective Studies
Risk Assessment
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / methods
Transcatheter Aortic Valve Replacement* / statistics & numerical data