Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 20;14(10):e039036.
doi: 10.1161/JAHA.124.039036. Epub 2025 May 15.

A Two-Step Risk Score for Prediction of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Alexandra Janiszewski  1   2 , Julia Lueg  1   2 , Daniel Schulze  3 , Benjamin Juri  1   2 , Louis Morell  1   2 , Maria Hajduczenia  1   2 , Pierre Hennig  1   2 , Aslihan Erbay  4   5 , Alexander Lembcke  2   6 , Stefan Niehues  2   6 , Ulf Landmesser  1   2 , Karl Stangl  1   2 , David Leistner  4   5 , Verena Tscholl  1   2 , Henryk Dreger  1   2   7   8
Affiliations

A Two-Step Risk Score for Prediction of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Alexandra Janiszewski et al. J Am Heart Assoc. .

Abstract

Background: The need for postoperative permanent pacemaker implantation (PPMI) remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). This study aimed to develop a novel, 2-step risk score to predict PPMI probability after TAVI and implement it into a user-friendly website. Our risk score addresses the data gap on current prosthesis generations and provides a new, clinically motivated approach to calculating PPMI risk.

Methods and results: Between January 2019 and December 2020, 1039 patients underwent TAVI at our institution. We retrospectively evaluated clinical, electrocardiographic, echocardiographic, computed tomographic, and periprocedural data. Patients with prior PPMI were excluded. We developed a prediction model for PPMI occurrence, using 55 patient and procedural characteristics. With exclusion criteria applied, 836 patients (mean age 80.3±9.1 years; 50.6% female) were included. Of these, 149 (17.8%) required PPMI within 30 days after TAVI. Fourteen preprocedural parameters, including preexisting right bundle-branch block, atrioventricular block, left bundle-branch block, bradycardia, interventricular septum thickness, New York Heart Association class, and aortic annulus perimeter, were identified as PPMI risk factors and used to calculate the baseline risk in the first step of the TAVI PACER score. The second step includes intraprocedural variables to demonstrate how PPMI risk can vary based on valve type and implantation depth. The TAVI PACER score predicts PPMI with a sensitivity of 76% and specificity of 72% (area under the curve=0.8).

Conclusions: The TAVI PACER score provides a novel tool for daily clinical practice, predicting individual PPMI risk after TAVI based on various patient and procedural characteristics.

Keywords: TAVI; aortic valve; pacemaker; risk score.

PubMed Disclaimer

Conflict of interest statement

Henryk Dreger received research support from Abbott, advisory board, and speaker's fees from Abbott and Edwards. Verena Tscholl received research support from Abbott and Zoll, as well as speaker fees from Novartis, Biotronik, Medtronic, and Astra Zeneca.

Figures

Figure 1
Figure 1. Study workflow.
CRT indicates cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PPM, permanent pacemaker; and TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2. Receiver operating characteristic curve analysis for the final model including periprocedural characteristics and interactions.
AUC indicates area under the curve.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, de Paulis R, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561–632. doi: 10.1093/eurheartj/ehab395 - DOI - PubMed
    1. Ciobanu AO, Gherasim L, Vinereanu D. Risk of stroke after transcatheter aortic valve implantation: epidemiology, mechanism, and management. Am J Ther. 2021;28:e560–e572. doi: 10.1097/MJT.0000000000001413 - DOI - PubMed
    1. Mangieri A, Montalto C, Poletti E, Sticchi A, Crimi G, Giannini F, Latib A, Capodanno D, Colombo A. Thrombotic versus bleeding risk after transcatheter aortic valve replacement: JACC review topic of the week. J Am Coll Cardiol. 2019;74:2088–2101. doi: 10.1016/j.jacc.2019.08.1032 - DOI - PubMed
    1. Anantha‐Narayanan M, Kandasamy VV, Reddy YN, Megaly M, Baskaran J, Pershad A, Suri RM, Garcia S. Low‐risk transcatheter versus surgical aortic valve replacement—an updated meta‐analysis of randomized controlled trials. Cardiovasc Revasc Med. 2020;21:441–452. doi: 10.1016/j.carrev.2019.08.003 - DOI - PubMed
    1. Blankenberg S, Seiffert M, Vonthein R, Baumgartner H, Bleiziffer S, Borger MA, Choi YH, Clemmensen P, Cremer J, Czerny M, et al. Transcatheter or surgical treatment of aortic‐valve stenosis. N Engl J Med. 2024;390:1572–1583. doi: 10.1056/NEJMoa2400685 - DOI - PubMed

LinkOut - more resources