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.


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