Left Ventricular Outflow Tract Geometry as a Predictor of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation Using the Evolut Series

Abstract

Background: Predicting the need for permanent pacemaker implantation (PPM) after transcatheter aortic valve implantation (TAVI) is crucial for procedural planning and patient counseling. Aims: To evaluate whether left ventricular outflow tract (LVOT) morphology, specifically a tapered configuration, predicts conduction disturbances requiring PPM after TAVI using the Evolut self-expanding valve. Methods: This retrospective multicenter study included patients undergoing TAVI with the self-expanding Evolut series. Pre-TAVI MSCT analysis included LVOT shape, membranous septum (MSep) length, and landing-zone calcification. Implantation depth (ID) was measured on final aortography. Results: A total of 189 patients were included (age, 79.2 ± 6.8 years, 46% female, EuroSCORE II, 3.1 [1.9, 5.6]). Seventeen patients (9%) required PPM at 30 days. Patients with a tapered LVOT had a threefold higher PPM rate compared with those with a non-tapered configuration (21% vs. 7%, p = 0.015). PPM was significantly associated with tapered LVOT (OR: 4.2, p = 0.041), pre-existing right bundle branch block (RBBB) (OR: 12.4, p = 0.001), and deep valve implantation with a short MSep (OR: 16.4, p < 0.001). Conclusion: Tapered LVOT configuration, pre-existing RBBB, and deep implantation in the context of a short MSep are independent predictors of PPM following TAVI with the Evolut TAVI platform. Integrating LVOT configuration and MSep length into preprocedural planning may improve patient selection and prediction of PPM.