Lower interventricular septal thickness from computed tomography predicts the need for pacemaker implantation after TAVR
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the standard treatment for severe aortic stenosis (AS) in select patients. While membranous septum length and pre-TAVR conduction disturbances are known predictors of permanent pacemaker implantation (PPI), the impact of muscular interventricular septal (IVS) thickness, assessed via pre-procedural computed tomography (CT), remains unclear. OBJECTIVES: The aim of the study was to evaluate the role of septal thickness with cardiac CT in predicting the need for PPI after TAVR. METHODS: This retrospective cohort study analyzed patients undergoing TAVR between January 2019 and December 2022. IVS thickness was measured in end-systole at various levels below the membranous septum on pre-procedural CT scans. Multivariable logistic regression models assessed predictors of PPI, including IVS thickness. RESULTS: Among the 338 patients (median age: 81 years; 42.6 % women), 20.1 % required PPI post-TAVR. Patients needing PPI had significantly lower IVS thickness 2 mm (3.9 ± 0.8 mm vs. 4.5 ± 1.3 mm, p < 0.001), 5 mm (5.9 ± 1.1 mm vs. 6.8 ± 1.8 mm, p < 0.001), and 10 mm (9.3 ± 1.1 mm vs. 10.6 ± 2.3 mm, p < 0.001) below the membranous septum. Multivariable analysis identified IVS thickness at 10 mm (HR: 0.73, 95 % CI: 0.56-0.96, p = 0.023), membranous septum length (HR: 0.79, 95 % CI: 0.67-0.94, p = 0.007), and right bundle branch block (HR: 7.70, 95 % CI: 3.70-15.90, p < 0.001) as independent predictors of PPI. CONCLUSIONS: IVS thickness on pre-procedural CT independently predicts PPI post-TAVR and improves risk stratification.
Authors: Manuel Garofalo, Valentina Scheggi, Yohann Bohbot, Jasim Hasan, Pierre Vanhaecke, Emilion Hucleux, Giorgia Panichella, Francesco Meucci, Ruggero Mazzotta, Samuele Salvi, Lucrezia Biagiotti, Matteo Orlandi, Angela Ilaria Fanizzi, Nicola Zoppetti, Renato Valenti, Matilde Papi, Antonio Fidanzati, Francesca Ciatti, Alessio Mattesini, Miroslava Stolcova, Manlio Acquafresca, Alberto Aimo, Gianluca Corcione, Alfredo Cerillo, Pier Luigi Stefàno, Dan Rusinaru, Anfani Mirode, Christophe Tribouilloy, Carlo Di Mario
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,970
OpenAlex ID: W4414400187