Journal Article

Comparative Prognostic Value of Risk Factors for Predicting Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Network Meta-Analysis

Molaei, Mohammad Mahdi, Shahrzad, Soraya, Karvane, Houshang Bavandpour, Tzeis, Stylianos, Mattumpuram, Jishanth, Hosseini, Kaveh, Zafari, Ali, Tavakoli, Kiarash, Riahi, Mobina, Jenab, Yaser, Vaseghi, Marmar, Hosseini Mohammadi, Negin Sadat, Khanipour, Ramtin, Lakkirrddy, Ghanunjaya R., Taebi, Morvarid, Farooqi, Mashood Ahmad

2025

Overview

This study compares the prognostic value of risk factors for Permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR). PubMed, Embase, Scopus, and Cochrane Library databases were searched until November 2024 for studies reporting PPI incidence within 30 days post-TAVR. A random-effect model was used to pool risk ratios (RR) and standardized mean differences (SDM) for binary and continuous risk factors. Network meta-analysis estimated pooled risk differences (ΔRR) for binary predictors with male sex as the reference. Significant predictors were ranked based on their surface under the cumulative ranking curve (SUCRA) values. A total of 108 studies comprising 77,538 patients (14,560 requiring PPI) were included. Male sex (RR: 1.13), baseline atrial fibrillation (AF) (RR: 1.12), 2nd degree Mobitz I (RR: 5.16) and Mobitz II (RR: 2.30) atrioventricular blocks (AVB), 3rd degree AVB (RR: 13.46), left anterior (LAHB) (RR: 1.79) and posterior hemiblocks (LPHB) (RR: 2.57), bifascicular block (RR: 2.34), right bundle branch block (RBBB) (RR: 3.20) and intraprocedural AVB (RR: 4.15) were identified as predictors for PPI post-TAVR. The risk of PPI was higher with self-expandable valves (RR: 1.79), subclavian access (RR: 1.75), and 29 mm prostheses (RR: 1.33) compared to balloon-expandable valves, transfemoral access, and 23 mm prostheses. Network meta-analysis ranked 3rd degree AVB (SUCRA <0.01), Mobitz I AVB (SUCRA: 0.14), Mobitz II AVB (SUCRA: 0.33), intraprocedural AVB (SUCRA: 0.42), bifascicular block (SUCRA: 0.48), RBBB (SUCRA: 0.49) and LPHB (SUCRA: 0.54) as major predictors of PPI in descending order of significance. In conclusion, clinicians should closely monitor conduction abnormalities as key predictors of PPI following TAVR. Additionally, other risk factors such as subclavian access, self-expanding implantation, AF, large prosthesis diameter, and male sex should not be overlooked. [Display omitted]

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abnormalities / Aorta / Aortic valve / Aortic Valve Stenosis - surgery / artificial / Atrial Fibrillation - epidemiology / atrioventricular block / Balloon treatment / Bias / Cardiac arrhythmia / cardiac conduction disorders / Cardiac Pacing, Artificial / Comparative analysis / Health risks / Heart failure / Heart valves / Humans / Implantation / Males / Medical prognosis / Meta-analysis / Observational studies / pacemaker / Pacemaker, Artificial / Pacemakers / Patients / Postoperative Complications - epidemiology / Postoperative Complications - therapy / Prognosis / Prostheses / Prosthetics / Pulmonary hypertension / Risk Assessment / Risk Factors / Sex / Systematic review / Transcatheter Aortic Valve Replacement