TAVI PACER: A two-step risk score for prediction of permanent pacemaker implantation after TAVI.

BackgroundThe need for permanent pacemaker implantation (PPMI) remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). This study aimed to develop a novel, two-step risk score to predict PPMI probability after TAVI and to implement it into a user-friendly website. Our risk score addresses the gap in existing data on current prosthesis generations and provides a new and clinically motivated approach to calculating the risk for PPMI. MethodsBetween January 2019 and December 2020, 1039 patients underwent TAVI at our institution. We retrospectively evaluated clinical, electrocardiographic, echocardiographic, computed tomographic, and periprocedural data. Patients with prior PPMI were excluded. We developed a prediction model for the occurrence of PPMI, initially using 55 patient and procedural characteristics. ResultsWe included 836 patients (mean age 80.2 {+/-} 9.1 years, 50.5% female), among whom 140 patients (16.6%) needed PPMI within 30 days after TAVI. In the first step, the TAVI PACER score calculates an individual risk for PPMI, including 14 preprocedural risk factors such as preexisting right bundle branch block, atrioventricular block, left bundle branch block, bradycardia, interventricular septum thickness in diastole, NYHA class, and aortic annulus perimeter. In the second step, intraprocedural variables are included to demonstrate how PPMI risk can vary based on the chosen valve type and implantation depth. The TAVI PACER score can predict PPMI with a sensitivity of 76% and specificity of 72% (AUC = 0.8). ConclusionsThe TAVI PACER score provides a novel tool for daily clinical practice, which predicts the individual risk for PPMI after TAVI based on various patient and two procedural characteristics. What Is KnownHigh-grade conduction disturbances are among the most common and clinically significant complications following TAVI. While recent research has extensively explored the factors leading to an increased risk of pacemaker implantation after TAVI, an established scoring system that considers individual patient risk profiles and predicts the likelihood of requiring a pacemaker before the procedure is still lacking. What the Study AddsWe developed a new two-step risk score called the TAVI PACER Score, which aims to close the gap in existing data on current prosthesis generations. In the first step, it considers various patient characteristics, and in the second step, it evaluates the impact of different procedural options on the necessity for pacemaker implantation. By calculating the individual pacemaker risk before the procedure and integrating it into treatment planning, our risk score aims to improve transparency in patient care, facilitate shared decision-making, and ultimately enhance the treatment outcomes of TAVI.