Incidence and Predictors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Procedures: Data of The Netherlands Heart Registration (NHR)

Abstract

Atrioventricular conduction disturbance leading to permanent pacemaker (PM) implantation is a frequent and relevant complication after transcatheter aortic valve implantation (TAVI). We aimed to evaluate the rate of post-TAVI permanent PM implantation over time and to identify the predictive factors for post-TAVI PM. The data were retrospectively collected by the Netherlands Heart Registration (NHR). In total, 7489 isolated TAVI patients between 2013 and 2019 were included in the final analysis. The primary endpoint was a permanent PM implantation within 30 days following TAVI. The incidence of the primary endpoint was 12%. Post-TAVI PM showed a stable rate over time. Using multivariable logistic regression analysis, age (OR 1.01, 95% CI 1.00–1.02), weight (OR 1.00, 95% CI 1.00–1.01), creatinine serum level (OR 1.15, 95% CI 1.01–1.31), transfemoral TAVI approach (OR 1.34, 95% CI 1.11–1.61), and TAVI post-dilatation (OR 1.58, 95% CI 1.33–1.89) were shown to be independent predictors of PM. Male sex (OR 0.80, 95% CI 0.68–0.93) and previous aortic valve surgery (OR 0.42, 95% CI 0.26–0.69) had a protective effect on post-TAVI PM. From a large national TAVI registry, some clinical and procedural factors have been identified as promoting or preventing post-TAVI PM. Further efforts are required to identify high-risk patients for post-TAVI PM and to reduce the incidence of this important issue.

Readmission rates and risk factors for readmission after transcatheter aortic valve replacement in patients with end-stage renal disease

“…The proportion of arrhythmia as a cause of readmission was similar in patients with (14%) and without (13%) ESRD, although twice as many readmissions occurred in the former. An analysis of the Netherlands Heart Registration reported serum creatinine level ≥1.13mg/dL to be significantly associated with pacemaker implantation at 30 days after TAVR, and a Swedish observational study also noted greater proportion of renal impairment in patients who had pacemakers placed after TAVR [ 28 , 29 ]. Our analysis also showed that patients with ESRD were readmitted within 90 days for atrioventricular block twice (3.0% versus 1.5%) as frequently compared with patients without ESRD.…”

Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation

“…However, a recent report using retrospectively analyzed data from the Netherlands Heart Registration, a very large national database, suggests that the male sex protects against requiring post-TAVI PPI. This may be because men, in general, have a larger aortic annulus and thus oversizing occurs less frequently [ 45 ]. How one is to reconcile these conflicting results remains unclear, but in the interim one could perhaps consider male sex to be at least a weak pre-procedural predictor for PPI.…”

“…Other patient-related factors that may be predictive, although studies have yielded inconsistent results, include BMI and serum creatinine. Both the substudy of the Pragmatic registry (OR 1.08, 95% CI 1.02–1.13, p < 0.004) and the Netherlands Heart Registration data suggest that, rather than seeing a protective “obesity paradox”, that increased BMI was associated with an increased risk of PPI [ 45 , 47 ]. Likewise, impaired renal function has been reported to be predictive of post-TAVI PPI in the Netherlands Heart Registration (OR 1.15, 95% CI 1.01–1.31, p < 0.04) and in a French national hospital database (OR 1.09, 95% CI 1.02–1.17, p < 0.01) [ 13 , 45 ].…”