Aortic valve calcification as a predictor of permanent pacemaker insertion after transcatheter aortic valve implantation

Aim . To assess the contribution of aortic valve (AV) calcification severity to permanent pacemaker (PP) insertion after transcatheter aortic valve implantation (TAVI) during the hospitalization. Material and methods . The study included 94 patients with severe aortic stenosis who underwent TAVI. All patients underwent multislice computed tomography (CT) before the procedure to assess AV calcification. Results . During the hospital period, eight patients (8,5%) required PP implantation. CT made it possible to reveal that patients who underwent pacemaker implantation after TAVI compared with patients without pacemaker had higher calcium volume in the left coronary cusp (LCC) (424,6 mm 3 [223,1-524,7] vs 151,6 mm 3 [91,9-276,2], respectively, p=0,005) and non-coronary cusp (608,2 mm 3 [254,5-805,2] vs 283,7 mm 3 [173,6-398,9], respectively, p=0,035). As a result of multivariate regression analysis, the independent predictors of pacemaker implantation after TAVI were the initial right bundle branch block (RBBB) (odds ratio (OR): 15,77; 95% confidence interval (CI): 2,06-120,5; p=0,008) and LCC calcium volume >300 mm 3 (OR: 7,98; 95% CI: 1,38-46,11; p=0,020). Conclusion . According to the study results, initial RBBB and LCC calcification are independent predictors of permanent pacemaker implantation after TAVI during the hospital period. Further studies are needed to predict and prevent post-operative complications.