Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Indications D-AB06 - Cardiac Resynchronization - LV and His Bundle Pacing! (ID 25) Abstract

D-AB06-05 - Clinical Performance Of Risk Prediction Model For Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement In Patients With Pre-existing Atrial Fibrillation: Single High Volume Center Experience (ID 1438)


Background: High-grade atrioventricular block (AVB) requiring cardiac implantable electronic device (CIED) implantation remains a significant sequela after transcatheter aortic valve replacement (TAVR). We previously reported a risk prediction model of this complication from 1071 patients who underwent TAVR from March 2011-October 2018 (presented at HRS2019) that included pre-existing first-degree AVB (1 point), self-expanding valve use (1 point), hypertension (1 point), and pre-existing right bundle branch block (RBBB) (2 points). However, this model may underestimate the outcome in patients with atrial fibrillation (AF).
Objective: The study aim was to evaluate the diagnostic accuracy of our prior model in TAVR patients with pre-existing AF.
Methods: This is a single center, retrospective study of patients who underwent TAVR from July 2015-November 2019. Patients with first generation prostheses and/or pre-existing CIED were excluded.
Results: Of 840 patients who underwent TAVR, 161 were found to have prior AF. Of the 161 patients, 33 (20.6%) required new CIED implantation. Baseline CKD and pre-existing RBBB were statistically associated with new CIED implantation (51.5% vs 29.9%: p=0.018; 48.5% vs 14.2%; p<0.001). Patient subgroup distribution was similar to our previous validation cohort (Figure A and B). This model preserved a high diagnostic accuracy with an ROC area under the curve: 0.696 (95% confidence interval 0.594-0.797) and an ideal linear regression in calibration plot (R2 0.833).
Conclusion: Our model accurately predicted the risk of CIED implantation after TAVR in patients with pre-existing AF. Multi-center prospective validation should be undertaken.