loading page

Predictors of Permanent Pacemaker Insertion after TAVR: A Systematic Review and Updated Meta-Analysis
  • +5
  • Rahul Gupta,
  • Aaqib Malik,
  • Pranav Mahajan,
  • Surya Aedma,
  • Wilbert Aronow,
  • Sanjay Mehta,
  • Dhanunjaya Lakkireddy
Carle Foundation Hospital

Corresponding Author:[email protected]

Author Profile
Rahul Gupta
Lehigh Valley Health Network
Author Profile
Aaqib Malik
Westchester Medical Center Health Network
Author Profile
Pranav Mahajan
Carle Foundation Hospital
Author Profile
Surya Aedma
Carle Foundation Hospital
Author Profile
Wilbert Aronow
Westchester Medical Center
Author Profile
Sanjay Mehta
Carle Foundation Hospital
Author Profile
Dhanunjaya Lakkireddy
The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest
Author Profile


Objectives: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following Transcatheter Aortic Valve Replacement (TAVR). Background: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common post-procedural complications. Methods: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results: 37 observational studies with 71,455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and non-coronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, pre-dilatation balloon valvuloplasty and post-implant balloon dilation. Conclusion: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
30 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
01 Sep 2020Submission Checks Completed
01 Sep 2020Assigned to Editor
06 Sep 2020Reviewer(s) Assigned
18 Nov 2020Review(s) Completed, Editorial Evaluation Pending
18 Nov 2020Editorial Decision: Revise Minor
17 Jan 20211st Revision Received
15 Feb 2021Submission Checks Completed
15 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
27 Feb 2021Review(s) Completed, Editorial Evaluation Pending
02 Mar 2021Editorial Decision: Accept