Possibilities of predicting the risk of developing cardiac conduction disorders after transcatheter aortic valve replacement

   Introduction. Cardiac conduction disturbances with the subsequent need for pacemaker implantation are a major clinical problem in the postoperative period of transcatheter aortic valve implantation (TAVI).

   The aim of the study. To develop multifactorial models for predicting the risk of developing cardiac conduction disturbances and pacemaker implantation after TAVI in the early postoperative period on a "training" sample of patients with an assessment of the diagnostic accuracy of the developed model on a "control" sample of patients.

   Material and methods. The study included 337 patients with severe or critical aortic stenosis who underwent TAVI from 2021 to 2022 in the laboratory of hybrid methods in the Department of cardiovascular surgery, Chazov National Medical Research Center, Ministry of Health of the Russian Federation

   Results. In constructing a model for predicting new (not registered before the operation) cardiac conduction disturbances after TAVI, the most significant predictors were: intraventricular conduction disturbances, the size of the aortic root, and the end-diastolic size of the left ventricle. The quality indicators of the model: AUC 0.711 (95 % CI: 0.644-0.778), sensitivity 77.7 % (95 % CI: 67.9-85.6), specificity 56.6 % (95 % CI: 47.8-65.1), PPV 55.3% (95 % CI: 46.5-67.9), NPV 78.5% (95 % CI: 69.1-84.0). Results of testing in the "control" sample: AUC 0.723 (95 % CI: 0.615-0.832). For the pacemaker implantation risk model predictors were: right bundle branch block, coronary heart disease and atrioventricular conduction disturbances. Model quality indicators: AUC 0.789 (95 % CI: 0.683-0.894), sensitivity 94.1 % (95% CI: 71.3-99.8), specificity 53.9 % (95 % CI: 47.0-60.7), PPV 13.8 % (95% CI: 10.8-87.0), NPV 99.2 % (95 % CI: 94.7-99.4). Results of verification on the control sample: AUC 0.795 (95 % CI 0.664-0.925).

   Discussion. The proposed models can be used in practice to assess the risk of developing cardiac conduction disorders and pacemaker implantation in patients who are scheduled to TAVI.

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