Predictors of permanent pacemaker implantation after TAVI with Navitor transcatheter heart valve.

Objective: This study aimed to identify predictors of permanent pacemaker implantation (PPI) within 30 days after transcatheter aortic valve implantation (TAVI) using the Navitor™ (Abbott Chicago, IL, USA) transcatheter heart valve (THV).

Results: This retrospective two-center study included 173 patients with severe aortic stenosis undergoing transfemoral TAVI with Navitor™ THV. Patients with prior pacemaker implantation and valve-in-valve procedures were excluded. Mean age was 81.5 ± 5.0 years, and 54 patients (31 %) required PPI; they were more often male (57 % vs. 37 %, p = 0.01), had higher left ventricular ejection fraction (55.3 ± 9.0 vs. 52.4 ± 9.2, p = 0.049), and higher rates of COPD (30 % vs. 16 %, p = 0.017) and pre-existing right bundle branch block (RBBB; 17 % vs. 0.8 %, p < 0.001). Procedural factors associated with PPI included greater annulus-to-THV oversizing (13.6 % ± 3.4 vs. 12.5 % ± 3.1, p = 0.041), implantation depth > 4 mm (75.9 % vs. 52.1 %, p = 0.002), and 29 mm valve size use (46.3 % vs. 26.9 %, p = 0.010). At multivariable analysis, COPD (OR 2.4, p = 0.049), pre-existing RBBB (OR 34.4, p = 0.001), annulus-to-THV oversizing (OR 1.2, p = 0.002), and implantation depth > 4 mm (OR 3.2, p = 0.007) were independent predictors of PPI. ROC analysis (AUC 0.58) identified an optimal cut-off of 15 % annulus-to-THV oversizing for predicting PPI.

Conclusions: Annulus-to-THV oversizing emerges as a novel independent predictor for PPI after TAVI with Navitor™ THV.