Left Ventricular Mechanical Dispersion as a Predictor of need for Pacemaker implantation after TAVI

Eur Heart J Cardiovasc Imaging. 2023 Nov 17:jead315. doi: 10.1093/ehjci/jead315. Online ahead of print.


Aims: Permanent pacemaker (PM) implantation is common after TAVI. Left ventricular mechanical dispersion (MeDi) by speckle tracking echocardiography is a marker of fibrosis that causes alterations in the conduction system. We hypothesized that MeDi can be a predictor of need for PM implantation after TAVI.

Methods and results: Consecutively, 200 TAVI patients were enrolled. Transthoracic echocardiography and electrocardiography examinations were recorded before TAVI to evaluate global longitudinal strain (GLS), MeDi and conduction disturbances. PM implantation information was obtained three months after TAVI. Patients were stratified into PM- or no-PM group. Mean age was 80 ± 7 years (44% women). Twenty-nine patients (16%) received PM. MeDi, QRS duration, existence of right bundle branch block (RBBB) and first-degree AV block were significantly different between groups. MeDi were 57 ± 15 ms and 48 ± 12 ms in PM and no-PM groups, respectively (p < 0.001). In multivariate analysis, MeDi predicted the need for PM after TAVI independently of GLS, QRS duration, RBBB and first-degree AV block (OR: 1.73, 95% CI: 1.22-2.45) with an AUC of 0.68 in ROC curves. Moreover, RBBB was an independent predictor of PM need after TAVI (OR: 8.98, 95% CI: 1.78-45.03). When added to RBBB, MeDi had an incremental predictive value with an AUC of 0.73 in ROC curves (p = 0.01).

Conclusion: MeDi may be used as an echocardiographic functional predictor of need for PM after TAVI.

Keywords: PM implantation; Speckle tracking echocardiography; Transcatheter aortic valve implantation; global longitudinal strain; mechanical dispersion.