Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 11, Number 3, June 2020, pages 155-167

Aortic Valve Calcification as a Predictor of Post-Transcatheter Aortic Valve Replacement Pacemaker Dependence

Figure 1. A total of 262 patients underwent transcatheter aortic valve replacement (TAVR), 36 patients were excluded from analysis because of pre-existing pacemakers and 25 patients required pacemaker implantation after TAVR for three different indications. All patients received a pacemaker check at 10 and 30 days. At 10 days, nine patients were no longer right ventricular (RV) pacing-dependent. At 30 days, 17 patients were no longer RV pacing-dependent. CHB: complete heart block; SSS: sick sinus syndrome; LBBB: left bundle branch block; PPM: permanent pacemaker.

Figure 2. (a) Unaligned view of the aortic annulus that is not in plane. The top-left is the axial view, bottom-left is the transverse view and the bottom-right is the sagittal view. (b) The right coronary cusp (RCC) is now visible in the axial view by adjusting the red axes. The green and purple axes are then centered on the insertion of the RCC. (c) The non-coronary cusp (NCC) insertion is aligned by adjusting the red axes in the sagittal image to bring it into plane with the RCC insertion in the axial view. (d) The purple axes are adjusted to run through both RCC and NCC insertions. Then, the red axes on the transverse view are adjusted to bring in the insertion of the left coronary cusp (LCC) into the same plane as the RCC and NCC.

Figure 3. (a) The aortic valve complex used for analysis is created using a batching tool to separate the study images from the larger, original. The batching tool is visible in the bottom left in the axial view as a box of green lines, and it is centered at the annular plane (red axes). It extends 5 mm caudally from the annular plane and cranially to the tip of the upper leaflets. Each green line represents 1 mm. The output at the level of the annular plane is in the top-right box, with the cusps labeled as right coronary cusp (RCC), left coronary cusp (LCC) and non-coronary cusp (NCC) for orientation. (b) Tool used to calculate mean attenuation in Hounsfield Units (HU) to adjust cutoffs for calcium scoring. In this image, the mean luminal attenuation is 456 HU, so a cutoff of 550 HU was used. (c) Zoomed in view of leaflet calcification in one slice of the upper leaflet zone for each leaflet. (d) Calcification of each leaflet in this slice in the upper leaflet zone was traced using calcium analysis software, which then provided a calcium score, volume and mean. In the device landing zone and annulus region, a total calcium score, volume and mean was provided.

Figure 4. The aortic valve complex was separated in the craniocaudal axis of the left ventricular outflow tract (LVOT)/aortic valve into the following regions: the LVOT region (from 5 mm below the annular plane to the annular plane, green), the device-landing zone (2 mm inferior to the annular plane to 3 mm superior to the annular plane, yellow) and the upper leaflet region (3 mm superior to the annular plan to the superior edge of the leaflets, blue). Each leaflet was separately quantified in the upper leaflet region. NCC: non-coronary cusp; LCC: left coronary cusp; RCC: right coronary cusp.

**Table 1.** Electrocardiographic Data, Clinical Imaging Data and Procedural Parameters of Non-RV Pacing-Dependent and RV Pacing-Dependent Patients at 1 Month Post-PPM Implant
	Non-RV pacing-dependent (n = 17)	RV pacing-dependent (n = 8)	P-value
The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. ^aValues obtained by transthoracic echocardiography. ^bValues obtained by multidetector computed tomography. RV: right ventricular; PPM: permanent pacemaker; AV: atrioventricular; LAFB: left anterior fascicular block; LPFB: left posterior fascicular block; RBBB: right bundle branch block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVEDd: left ventricular end diastolic diameter; LVOTd: left ventricular outflow tract diameter; MAC: mitral annular calcification; TAVR: transcatheter aortic valve replacement; CHB: complete heart block; SSS: sick sinus syndrome; LVOT: left ventricular outflow tract.
Electrocardiographic data
Sinus	11/17	7/8	0.36
First-degree AV block	3/17	2/8	1
LAFB	4/17	3/8	0.64
LPFB	1/17	1/8	1
RBBB	2/17	8/8	< 0.0001
LBBB	1/17	0/8	1
Bifascicular block	2/17	5/8	0.017
QRS duration > 120 ms	3/17	8/8	0.0002
QRS duration (ms)	108.4 ± 22.0	138.8 ± 14.1	0.0017
Clinical imaging data
Aortic valve area^a	0.65 ± 0.23	0.77 ± 0.26	0.23
LVEF^a	52.1 ± 13.9	59.4 ± 11.8	0.21
LVOTd^a	2.04 ± 0.33	2.10 ± 0.22	0.64
LVEDd^a	4.94 ± 0.80	4.64 ± 0.84	0.43
Aortic annulus diameter^b	2.37 ± 0.30	2.51 ± 0.22	0.25
Aortic annulus area^b	4.48 ± 1.12	5.06 ± 0.79	0.21
Severe MAC	4/17	0/8	0.28
Procedural parameters
Transfemoral approach	13/17	8/8	0.27
Transapical approach	4/17	0/8	0.27
Intra-procedural complete heart block	6/17	7/8	0.03
Valve size	25.3 ± 2.5	25.3 ± 2.1	0.97
Valve/LVOTd^a	12.6 ± 1.8	12.1 ± 1.1	0.45
Days post-TAVR of pacemaker insertion	5.24 ± 3.44	5.88 ± 6.31	0.74
Paravalvular leak requiring post-dilation	7/17	1/8	0.21
Percent oversizing by annulus area^b	13.7 ± 15.3	-0.03 ± 12.7	0.04
Generation
SAPIEN	12/17	5/8	1
SAPIEN XT	3/17	0/8	0.53
SAPIEN III	2/17	3/8	0.28
Pacemaker indication
CHB	12/17	8/8	0.14
SSS	3/17	0/8	0.53
New LBBB	2/17	0/8	0.55

Table 1. Electrocardiographic Data, Clinical Imaging Data and Procedural Parameters of Non-RV Pacing-Dependent and RV Pacing-Dependent Patients at 1 Month Post-PPM Implant

Non-RV pacing-dependent (n = 17)

RV pacing-dependent (n = 8)

P-value

The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. ^aValues obtained by transthoracic echocardiography. ^bValues obtained by multidetector computed tomography. RV: right ventricular; PPM: permanent pacemaker; AV: atrioventricular; LAFB: left anterior fascicular block; LPFB: left posterior fascicular block; RBBB: right bundle branch block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVEDd: left ventricular end diastolic diameter; LVOTd: left ventricular outflow tract diameter; MAC: mitral annular calcification; TAVR: transcatheter aortic valve replacement; CHB: complete heart block; SSS: sick sinus syndrome; LVOT: left ventricular outflow tract.

Electrocardiographic data

Sinus

11/17

7/8

0.36

First-degree AV block

3/17

2/8

LAFB

4/17

3/8

0.64

LPFB

1/17

1/8

RBBB

2/17

8/8

< 0.0001

LBBB

1/17

0/8

Bifascicular block

2/17

5/8

0.017

QRS duration > 120 ms

3/17

8/8

0.0002

QRS duration (ms)

108.4 ± 22.0

138.8 ± 14.1

0.0017

Clinical imaging data

Aortic valve area^a

0.65 ± 0.23

0.77 ± 0.26

0.23

LVEF^a

52.1 ± 13.9

59.4 ± 11.8

0.21

LVOTd^a

2.04 ± 0.33

2.10 ± 0.22

0.64

LVEDd^a

4.94 ± 0.80

4.64 ± 0.84

0.43

Aortic annulus diameter^b

2.37 ± 0.30

2.51 ± 0.22

0.25

Aortic annulus area^b

4.48 ± 1.12

5.06 ± 0.79

0.21

Severe MAC

4/17

0/8

0.28

Procedural parameters

Transfemoral approach

13/17

8/8

0.27

Transapical approach

4/17

0/8

0.27

Intra-procedural complete heart block

6/17

7/8

0.03

Valve size

25.3 ± 2.5

25.3 ± 2.1

0.97

Valve/LVOTd^a

12.6 ± 1.8

12.1 ± 1.1

0.45

Days post-TAVR of pacemaker insertion

5.24 ± 3.44

5.88 ± 6.31

0.74

Paravalvular leak requiring post-dilation

7/17

1/8

0.21

Percent oversizing by annulus area^b

13.7 ± 15.3

-0.03 ± 12.7

0.04

Generation

SAPIEN

12/17

5/8

SAPIEN XT

3/17

0/8

0.53

SAPIEN III

2/17

3/8

0.28

Pacemaker indication

CHB

12/17

8/8

0.14

SSS

3/17

0/8

0.53

New LBBB

2/17

0/8

0.55

**Table 2.** Baseline Characteristics and Comparison of Patients Not Requiring PPM Implant and Those Requiring PPM Implant Post-TAVR
	No PPM (n = 201)	Non-RV pacing-dependent at 30 days (n = 17)	P-value	Pacing-dependent at 30 days (n = 8)	P-value
The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. PPM: permanent pacemaker; TAVR: transcatheter aortic valve replacement; RV: right ventricular; BMI: body mass index; DM: diabetes mellitus; CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; PVD: peripheral vascular disease; eGFR: estimated glomerular filtration rate; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker; AV: atrioventricular; LAFB: left anterior fascicular block; LPFB: left posterior fascicular block; RBBB: right bundle branch block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVOTd: left ventricular outflow tract diameter.
Age	82.2 ± 8.3	80.4 ± 6.3	0.39	80.9 ± 8.3	0.66
Gender (female)	102/201	8/17	0.81	2/8	0.28
BMI	27.2 ± 6.3	29.1 ± 6.3	0.27	25.0 ± 4.5	0.32
Hypertension	185/201	15/17	0.64	5/8	0.03
DM	70/201	10/17	0.066	2/8	0.72
CAD	157/201	14/17	0.77	5/8	0.38
CHF	142/201	13/17	0.78	5/8	0.70
COPD	37/201	2/17	0.55	1/8	1
PVD	29/201	4/17	0.48	1/8	1
History of atrial fibrillation	69/201	6/17	1	2/8	0.72
History of atrial flutter	26/175	1/17	0.49	1/8	1
eGFR < 60	97/201	10/17	0.46	7/8	0.035
Creatinine	1.12 ± 0.54	1.36 ± 0.61	0.09	1.92 ± 1.42	0.0002
Prior CABG	66/201	7/17	0.59	2/8	0.73
Prior PCI	74/201	3/17	0.12	3/8	1
Prior balloon valvuloplasty	25/201	5/17	0.065	0/8	0.60
ACE-I/ARB	106/201	7/17	0.45	5/8	0.73
Beta-blockers	144/201	10/17	0.28	6/8	1
Digoxin	13/201	0/17	0.41	0/8	1
Other anti-arrhythmic drugs	12/201	0/17	0.61	0/8	1
Sinus rhythm	161/200	11/17	0.21	7/8	1
First-degree AV block	42/200	3/17	1	2/8	1
LAFB	27/200	4/17	0.28	3/8	0.09
LPFB	1/200	1/17	0.15	1/8	0.08
RBBB	18/200	2/17	1	8/8	< 0.0001
LBBB	22/200	1/17	0.70	0/8	0.60
Bifascicular block	9/200	2/17	0.21	5/8	< 0.0001
QRS duration > 120 ms	48/200	3/17	0.77	8/8	< 0.0001
QRS duration (ms)	106.1 ± 24.2	108.4 ± 22.0	0.71	138.8 ± 14.1	0.0002
Aortic valve area	0.66 ± 0.23	0.65 ± 0.23	0.78	0.77 ± 0.26	0.19
LVEF	56.4 ± 13.4	52.1 ± 13.9	0.21	59.4 ± 11.8	0.53
LVOTd	2.02 ± 0.22	2.04 ± 0.33	0.74	2.1 ± 0.22	0.31
Transfemoral approach	155/201	13/17	1	8/8	0.20
Transapical approach	36/201	4/17	0.74	0/8	0.36
Intra-procedural complete heart block	17/201	6/17	0.004	7/8	< 0.0001
Valve size	25.0 ± 2.3	25.3 ± 2.5	0.60	25.3 ± 2.1	0.75
Valve/LVOTd	12.5 ± 1.3	12.6 ± 1.8	0.71	12.1 ± 1.1	0.38
Percent oversizing by annulus area	11.3 ± 18.0	13.7 ± 15.3	0.60	-0.03 ± 12.7	0.08

Table 2. Baseline Characteristics and Comparison of Patients Not Requiring PPM Implant and Those Requiring PPM Implant Post-TAVR

No PPM (n = 201)

Non-RV pacing-dependent at 30 days (n = 17)

P-value

Pacing-dependent at 30 days (n = 8)

P-value

The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. PPM: permanent pacemaker; TAVR: transcatheter aortic valve replacement; RV: right ventricular; BMI: body mass index; DM: diabetes mellitus; CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; PVD: peripheral vascular disease; eGFR: estimated glomerular filtration rate; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker; AV: atrioventricular; LAFB: left anterior fascicular block; LPFB: left posterior fascicular block; RBBB: right bundle branch block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVOTd: left ventricular outflow tract diameter.

Age

82.2 ± 8.3

80.4 ± 6.3

0.39

80.9 ± 8.3

0.66

Gender (female)

102/201

8/17

0.81

2/8

0.28

BMI

27.2 ± 6.3

29.1 ± 6.3

0.27

25.0 ± 4.5

0.32

Hypertension

185/201

15/17

0.64

5/8

0.03

70/201

10/17

0.066

2/8

0.72

CAD

157/201

14/17

0.77

5/8

0.38

CHF

142/201

13/17

0.78

5/8

0.70

COPD

37/201

2/17

0.55

1/8

PVD

29/201

4/17

0.48

1/8

History of atrial fibrillation

69/201

6/17

2/8

0.72

History of atrial flutter

26/175

1/17

0.49

1/8

eGFR < 60

97/201

10/17

0.46

7/8

0.035

Creatinine

1.12 ± 0.54

1.36 ± 0.61

0.09

1.92 ± 1.42

0.0002

Prior CABG

66/201

7/17

0.59

2/8

0.73

Prior PCI

74/201

3/17

0.12

3/8

Prior balloon valvuloplasty

25/201

5/17

0.065

0/8

0.60

ACE-I/ARB

106/201

7/17

0.45

5/8

0.73

Beta-blockers

144/201

10/17

0.28

6/8

Digoxin

13/201

0/17

0.41

0/8

Other anti-arrhythmic drugs

12/201

0/17

0.61

0/8

Sinus rhythm

161/200

11/17

0.21

7/8

First-degree AV block

42/200

3/17

2/8

LAFB

27/200

4/17

0.28

3/8

0.09

LPFB

1/200

1/17

0.15

1/8

0.08

RBBB

18/200

2/17

8/8

< 0.0001

LBBB

22/200

1/17

0.70

0/8

0.60

Bifascicular block

9/200

2/17

0.21

5/8

< 0.0001

QRS duration > 120 ms

48/200

3/17

0.77

8/8

< 0.0001

QRS duration (ms)

106.1 ± 24.2

108.4 ± 22.0

0.71

138.8 ± 14.1

0.0002

Aortic valve area

0.66 ± 0.23

0.65 ± 0.23

0.78

0.77 ± 0.26

0.19

LVEF

56.4 ± 13.4

52.1 ± 13.9

0.21

59.4 ± 11.8

0.53

LVOTd

2.02 ± 0.22

2.04 ± 0.33

0.74

2.1 ± 0.22

0.31

Transfemoral approach

155/201

13/17

8/8

0.20

Transapical approach

36/201

4/17

0.74

0/8

0.36

Intra-procedural complete heart block

17/201

6/17

0.004

7/8

< 0.0001

Valve size

25.0 ± 2.3

25.3 ± 2.5

0.60

25.3 ± 2.1

0.75

Valve/LVOTd

12.5 ± 1.3

12.6 ± 1.8

0.71

12.1 ± 1.1

0.38

Percent oversizing by annulus area

11.3 ± 18.0

13.7 ± 15.3

0.60

-0.03 ± 12.7

0.08

**Table 3.** Baseline Demographic and Clinical Characteristics of Non-RV Pacing-Dependent and Pacing-Dependent Patients at 1 Month Post-PPM Implant
	Non-RV pacing-dependent (n = 17)	RV pacing-dependent (n = 8)	P-value
The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. RV: right ventricular; PPM: permanent pacemaker; BMI: body mass index; DM: diabetes mellitus; CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; PVD: peripheral vascular disease; eGFR: estimated glomerular filtration rate; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker.
Age	80.4 ± 6.3	80.9 ± 8.3	0.88
Gender (female)	8/17	2/8	0.40
BMI	29.1 ± 6.3	25.0 ± 4 .5	0.12
Hypertension	15/17	5/8	0.28
DM	10/17	2/8	0.2
CAD	14/17	5/8	0.34
CHF	13/17	5/8	0.64
COPD	2/17	1/8	1
PVD	4/17	1/8	0.64
History of atrial fibrillation	6/17	2/8	0.68
History of atrial flutter	1/17	1/8	1
eGFR < 60	10/17	7/8	0.21
Creatinine	1.36 ± 0.61	1.92 ± 1.42	0.19
Prior CABG	7/17	2/8	0.66
Prior PCI	3/17	3/8	0.34
Prior balloon valvuloplasty	5/17	0/8	0.14
ACE-I/ARB	7/17	5/8	0.41
Beta-blockers	10/17	6/8	0.66
Digoxin	0/17	0/8	1
Other anti-arrhythmic drugs	0/17	0/8	1

Table 3. Baseline Demographic and Clinical Characteristics of Non-RV Pacing-Dependent and Pacing-Dependent Patients at 1 Month Post-PPM Implant

Non-RV pacing-dependent (n = 17)

RV pacing-dependent (n = 8)

P-value

The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables and two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared with the non-pacemaker population to derive these P-values. Continuous variables are reported as the mean plus or minus the standard deviation. RV: right ventricular; PPM: permanent pacemaker; BMI: body mass index; DM: diabetes mellitus; CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; PVD: peripheral vascular disease; eGFR: estimated glomerular filtration rate; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker.

Age

80.4 ± 6.3

80.9 ± 8.3

0.88

Gender (female)

8/17

2/8

0.40

BMI

29.1 ± 6.3

25.0 ± 4 .5

0.12

Hypertension

15/17

5/8

0.28

10/17

2/8

0.2

CAD

14/17

5/8

0.34

CHF

13/17

5/8

0.64

COPD

2/17

1/8

PVD

4/17

1/8

0.64

History of atrial fibrillation

6/17

2/8

0.68

History of atrial flutter

1/17

1/8

eGFR < 60

10/17

7/8

0.21

Creatinine

1.36 ± 0.61

1.92 ± 1.42

0.19

Prior CABG

7/17

2/8

0.66

Prior PCI

3/17

3/8

0.34

Prior balloon valvuloplasty

5/17

0/8

0.14

ACE-I/ARB

7/17

5/8

0.41

Beta-blockers

10/17

6/8

0.66

Digoxin

0/17

0/8

Other anti-arrhythmic drugs

0/17

0/8

**Table 4.** Aortic Valve Complex Calcification
	RV pacing-dependent at 30 days (n = 8)	Non-RV pacing-dependent at 30 days (n = 16)	P-value
The P-values shown are derived from two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared. Continuous variables are reported as the mean plus or minus the standard deviation. HU: Hounsfield Units; LVOT: left ventricular outflow tract; RCC: right coronary cusp; NCC: non-coronary cusp; LCC: left coronary cusp; RV: right ventricular.
Mean attenuation	336.6 ± 87.6	353.8 ± 120.2	0.72
HU cutoff	353.8 ± 70.7	539.8 ± 66.9	0.62
Total calcium volume	783.5 ± 622.1	420.3 ± 264.2	0.055
LVOT calcium volume	673.7 ± 202.8	697.6 ± 34.7	0.18
Annulus calcium volume	117.9 ± 120.6	92.9 ± 50.4	0.48
RCC leaflet calcium volume	119.7 ± 121.5	107.2 ± 119.9	0.81
NCC leaflet calcium volume	342.0 ± 290.8	113.6 ± 63.2	0.006
LCC leaflet calcium volume	139.9 ± 132.7	91.4 ± 87.0	0.29
Total leaflet calcium volume	601.6 ± 504.9	312.2 ± 248.8	0.07

Table 4. Aortic Valve Complex Calcification

RV pacing-dependent at 30 days (n = 8)

Non-RV pacing-dependent at 30 days (n = 16)

P-value

The P-values shown are derived from two-tailed unpaired Student’s t-test for continuous variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared. Continuous variables are reported as the mean plus or minus the standard deviation. HU: Hounsfield Units; LVOT: left ventricular outflow tract; RCC: right coronary cusp; NCC: non-coronary cusp; LCC: left coronary cusp; RV: right ventricular.

Mean attenuation

336.6 ± 87.6

353.8 ± 120.2

0.72

HU cutoff

353.8 ± 70.7

539.8 ± 66.9

0.62

Total calcium volume

783.5 ± 622.1

420.3 ± 264.2

0.055

LVOT calcium volume

673.7 ± 202.8

697.6 ± 34.7

0.18

Annulus calcium volume

117.9 ± 120.6

92.9 ± 50.4

0.48

RCC leaflet calcium volume

119.7 ± 121.5

107.2 ± 119.9

0.81

NCC leaflet calcium volume

342.0 ± 290.8

113.6 ± 63.2

0.006

LCC leaflet calcium volume

139.9 ± 132.7

91.4 ± 87.0

0.29

Total leaflet calcium volume

601.6 ± 504.9

312.2 ± 248.8

0.07

**Table 5.** Predictors of Persistent RV Pacing After PPM Implantation
	RV pacing-dependent (n = 8)	Non-RV pacing-dependent (n = 17)	Odds ratio (95% CI)	P-value
The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared. RBBB: right bundle branch block; CI: confidence interval; NCC: non-coronary cusp; RV: right ventricular; PPM: permanent pacemaker.
RBBB	8/8	2/17	105.4 (4.52 - 2,458.5)	0.004
Bifascicular block	5/8	2/17	12.50 (1.6 - 97.65)	0.02
QRS duration > 120 ms	8/8	3/17	70.43 (3.23 - 1,535.22)	0.007
Intra-procedural complete heart block	7/8	6/17	12.83 (1.26 - 130.52)	0.03
NCC volume > 239.2 mm³	6/8	0/16	85.80 (3.61 - 2,041.00)	0.006

Table 5. Predictors of Persistent RV Pacing After PPM Implantation

RV pacing-dependent (n = 8)

Non-RV pacing-dependent (n = 17)

Odds ratio (95% CI)

P-value

The P-values shown are derived from two-tailed Fisher’s exact test for categorical variables. Patients who were non-RV pacing-dependent at 30 days and patients who were RV pacing-dependent at 30 days patients were separately compared. RBBB: right bundle branch block; CI: confidence interval; NCC: non-coronary cusp; RV: right ventricular; PPM: permanent pacemaker.

RBBB

8/8

2/17

105.4 (4.52 - 2,458.5)

0.004

Bifascicular block

5/8

2/17

12.50 (1.6 - 97.65)

0.02

QRS duration > 120 ms

8/8

3/17

70.43 (3.23 - 1,535.22)

0.007

Intra-procedural complete heart block

7/8

6/17

12.83 (1.26 - 130.52)

0.03

NCC volume > 239.2 mm³

6/8

0/16

85.80 (3.61 - 2,041.00)

0.006