Current knowledge for the risk factors of early permanent pacemaker implantation following transcatheter aortic valve replacement and what is next for the primary prevention?

In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.

Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement:The role of machine learning

BACKGROUND Atrioventricular block requiring permanent pacemaker(PPM)implantation is an important complication of transcatheter aortic valve replacement(TAVR).Application of machine learning could potentially be used to predict preprocedural risk for PPM.AIM To apply machine learning to be used to predict pre-procedural risk for PPM.METHODS A retrospective study of 1200 patients who underwent TAVR(January 2014-December 2017)was performed.964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis.After the exclusion of variables with near-zero variance or≥50%missing data,167 variables were included in the random forest gradient boosting algorithm(GBM)optimized using 5-fold cross-validations repeated 10 times.The receiver operator curve(ROC)for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.RESULTS Of 964 patients included in the 30-d analysis without prior PPM,19.6%required PPM post-TAVR.The mean age of patients was 80.9±8.7 years.42.1%were female.Of 657 patients included in the 1-year analysis,the mean age of the patients was 80.7±8.2.Of those,42.6%of patients were female and 26.7%required PPM at 1-year post-TAVR.The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model(0.66 and 0.72)was superior to that of the PPM risk score(0.55 and 0.54)with a P value<0.001.CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.

Subclavian Arterial Bleeding during Permanent Pacemaker Implantation: Clinical Case Report and Literature Review

Research objective: To study a clinical case that had a complication of subclavian artery bleeding during permanent pacemaker implantation process. Subject and Method: Clinical case report and literature review. Study of a patient had an indication for permanent pacemaker implantation who had complication of subclavian artery bleeding during the procedure. Result: An 84-year-old female patient was admitted to the hospital because of fainting spells with chest pain, on the background of dangerous complex arrhythmias and ischemic heart disease, and was prescribed a pacemaker for this patient. The patient had complication occurred during the procedure, which left subclavian artery bleeding was detected and treated promptly, a cardiac pacemaker was implanted on the right side of the chest, and the patient had a successful endovascular stent cover in the left subclavian artery. Conclude: Subclavian artery bleeding is a rare complication in the procedure of permanent pacemaker implantation, but it can still occur and requires quick detection and timely treatment, needs to be successful in cardiac pacemaker placement and subclavian artery drug-eluting stent cover placement intervention. Individualized patient risk assessment is needed;appropriate and standardized intervention techniques and experience can reduce the occurrence of this variable.

Successful transcatheter arterial embolization treatment for chest wall haematoma following permanent pacemaker implantation: A case report

BACKGROUND Haematoma is one of the main complications associated with pacemaker implantation.Pseudoaneurysm is a rare condition that is not easy to identify and is often overlooked.CASE SUMMARY A female patient diagnosed with high-grade atrioventricular block underwent permanent pacemaker implantation.During the operation,puncturing a small branch of the right subclavian artery developed into a pseudoaneurysm and resulted in further haematoma formation.Conventional treatment of compression haemostasis and haemostatic drugs was not effective.A series of timely transcatheter arterial embolizations avoided serious complications.CONCLUSION More possible conditions should be taken into consideration as haematoma is discovered,and timely treatment might prevent severe adverse events.

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation

BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.