Author + information
- Received August 26, 2019
- Revision received October 21, 2019
- Accepted October 24, 2019
- Published online March 16, 2020.
- Takahiro Tsushima, MDa,
- Fahd Nadeem, MDb,
- Sadeer Al-Kindi, MDb,
- Joshua R. Clevenger, MDb,
- Eric J. Bansal, MDb,
- Heather L. Wheat, MDa,
- Ankur Kalra, MDb,
- Guilherme F. Attizzani, MDb,
- Yakov Elgudin, MD, PhDc,
- Alan Markowitz, MDc,
- Marco A. Costa, MD, PhDb,
- Daniel I. Simon, MDb,
- Mauricio S. Arruda, MDb,
- Judith A. Mackall, MDb and
- Sergio G. Thal, MDb,∗ ()
- aDepartment of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- bDepartment of Medicine, Division of Cardiology, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- cDepartment of Surgery, Division of Cardiac Surgery, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Sergio G. Thal, Lead Management Program, Electrophysiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106.
Objectives The aim of this study was to develop and validate a risk prediction model for high-grade atrioventricular block requiring cardiac implantable electronic device (CIED) implantation after transcatheter aortic valve replacement (TAVR).
Background High-grade atrioventricular block requiring CIED remains a significant sequelae following TAVR. Although several pre-operative characteristics have been associated with the risk of post-operative CIED implantation, an accurate and validated risk prediction model is not established yet.
Methods This was a single center, retrospective study of consecutive patients who underwent TAVR from March 10, 2011, to October 8, 2018. This cohort sample was randomly divided into a derivation cohort (group A) and a validation cohort (group B). A scoring system for risk prediction of post-TAVR CIED implantation was devised using logistic regression estimates in group A and the calibration and validation were done in group B.
Results A total of 1,071 patients underwent TAVR during the study period. After excluding pre-existing CIED, a total of 888 cases were analyzed (group A: 507 and group B: 381). Independent predictive variables were as follows: self-expanding valve (1 point), hypertension (1 point), pre-existing first-degree atrioventricular block (1 point), and right bundle branch block (2 points). The resulting score was calculated from the total points. The internal validation in group B showed an ideal linear relationship in calibration plot (R2 = 0.933) and a good predictive accuracy (area under the curve: 0.693; 95% confidence interval: 0.627 to 0.759).
Conclusions This prediction model accurately predicts post-operative risk of CIED implantation with simple pre-operative parameters.
- atrioventricular block
- cardiac implantable electronic device
- risk prediction
- transcatheter aortic valve replacement
Dr. Attizzani is a consultant to Medtronic. Dr. Simon has received honoraria for work as a course director from Medtronic. Dr. Mackall has received consulting honoraria from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 26, 2019.
- Revision received October 21, 2019.
- Accepted October 24, 2019.
- 2020 American College of Cardiology Foundation
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