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. 2025 Jan 20;21(2):e119-e129.
doi: 10.4244/EIJ-D-24-00850.

Development and validation of the D-PACE scoring system to predict delayed high-grade conduction disturbances after transcatheter aortic valve implantation

Francesco Bendandi  1   2 , Nevio Taglieri  1 , Leonardo Ciurlanti  1 , Alessandro Mazzapicchi  1 , Marco Foroni  1 , Laura Lombardi  1 , Francesco Palermo  1 , Francesco Filice  1 , Gabriele Ghetti  1 , Antonio Giulio Bruno  1 , Mateusz Orzalkiewicz  1 , Giuliano Costa  3 , Valentina Frittitta  3 , Alessandro Comis  3 , Sofia Sammartino  3 , Maria Chiara Calì  3 , Elena Dipietro  3 , Luigi La Rosa  3 , Corrado Tamburino  3 , Tullio Palmerini  1 , Marco Barbanti  3   4 , Francesco Saia  1
Affiliations

Development and validation of the D-PACE scoring system to predict delayed high-grade conduction disturbances after transcatheter aortic valve implantation

Francesco Bendandi et al. EuroIntervention. .

Abstract

Background: New conduction disturbances are frequent after transcatheter aortic valve implantation (TAVI). Refining our ability to predict high-grade atrioventricular block (AVB) occurring later than 24 hours after the procedure would be useful in order to select patients eligible for early discharge.

Aims: This study was designed to identify predictors of high-grade AVB occurring between 24 hours and 30 days after TAVI and to develop and validate a predictive risk score.

Methods: We analysed clinical, procedural, and electrocardiographic parameters of 1,290 TAVI patients. Independent predictors of delayed high-grade AVB were used to develop the predictive score, which was then externally validated in a cohort of 936 patients.

Results: Implantation of self-expanding valves, greater implantation depth, longer PR interval in preprocedural electrocardiogram (ECG) and greater increase of PR duration in next-day ECG, preprocedural right bundle branch block (RBBB) and new-onset left bundle branch block or RBBB that persisted in next-day ECG were independent predictors of delayed high-grade AVB and were combined to develop the Delayed atrioventricular block Prediction for eArly disChargE (D-PACE) score. The areas under the curve of the score were 0.879 (95% confidence interval [CI]: 0.835-0.923) and 0.799 (95% CI: 0.730-0.868) in the derivation and validation cohorts, respectively. Based on the score, patients can be classified into three risk categories; low-risk patients demonstrated an incidence of delayed AVB of less than 1% and are ideal candidates for next-day discharge.

Conclusions: The D-PACE score can be used to stratify TAVI patients according to their risk of delayed high-grade AVB and thereby identify those suitable for next-day discharge.

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Conflict of interest statement

F. Saia has received consulting and lecture fees from Abbott, Edwards Lifesciences, and Medtronic. T. Palmerini has received speaker fees from Edwards Lifesciences and Medtronic. The other authors have no conflicts of interest regarding the content of the study to declare.

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