Prognostic impact of new permanent pacemaker implantation following transcatheter aortic valve replacement

Abstract

BackgroundConduction disturbances requiring permanent pacemaker implantation (PPI) are common following transcatheter aortic valve replacement (TAVR). There were conflicting data regarding the impact of new PPI on clinical outcomes after TAVR.ObjectivesThe study sought to evaluate the impact of new PPI on clinical outcomes in patients undergoing TAVR.MethodsThis study was a retrospective analysis of prospectively collected data. Data were from 210 consecutive patients without prior PPI who underwent TAVR due to severe symptomatic aortic stenosis at our center between June 2018 and July 2020. Clinical, echocardiographic, and pacing data were assessed at 30‐day, 1‐ and 2‐year follow‐up.ResultsNew PPI was required in 35 (16.7%) patients within 30 days after TAVR. The median time from TAVR to PPI was 3 days. The most common indication for PPI was high‐degree or complete atrioventricular block. The median follow‐up was 798.0 (interquartile range, 669.0–1115.0) days. There were no differences in all‐cause mortality (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.85–2.36; p = 0.415) and cardiovascular mortality (adjusted HR: 0.92; 95% CI: 0.57–1.89; p = 0.609) between groups. However, PPI group had a higher risk of heart failure (HF) rehospitalization (adjusted HR: 1.53; 95% CI: 1.26–2.28; p = 0.027). Echocardiography showed no significant improvement of LVEF over time in patients with PPI. At the latest follow‐up, 31.3% of patients exhibited low (≤10%) pacing burdens, whereas 28.1% of patients had near constant (>90%) right ventricular pacing.ConclusionsNew PPI within 30 days following TAVR was not associated with an increased risk of all‐cause or cardiovascular mortality. However, patients with PPI had a higher risk of HF rehospitalization and lack of LVEF improvement.

Low Left-Ventricular Ejection Fraction as a Predictor of Intraprocedural Cardiopulmonary Resuscitation in Patients Undergoing Transcatheter Aortic Valve Implantation

“…In addition, patients with a low EF had a slightly lower rate of new pacemaker implantation (11.0% vs. 12.0%, p = 0.933). This trend, while not reaching significance, provides encouraging results, considering that ventricular pacing can negatively impact outcomes in individuals with a reduced EF [21].…”

Prognosis and Predictor Factors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: A Retrospective Analysis of the Post-Transcatheter Aortic Replacement Clairval Hospital Registry

“…In this study, the rate of PPI was elevated at 21.5%, with a higher prevalence observed in patients receiving self-expandable valves (35.6%). While this rate exceeded that of contemporary cohorts [ 9 , 10 , 11 ], the range across the literature was highly variable, ranging from 3.4% to 25.9%, according to the 2021 guidelines on cardiac pacing [ 12 ]. Several factors contributed to this variability.…”

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

“…It is unclear whether new PPI after TAVR is associated with poorer prognostic outcomes or simply indicative of patients at elevated risk. While the PPI effectively protects against severe atrioventricular block and life-threatening insidious chronic arrhythmias ( 101 ), early evidence indicates a potential link between persistent high-frequency right ventricular pacing (RVP) and an increased risk of cardiovascular death and heart failure rehospitalization ( 102 ). Bruno's multicenter study with a 6-month follow-up on patients who underwent PPI after TAVR revealed that those with RVP ≥ 40% had significantly higher risks of cardiovascular death and hospitalization for heart failure than patients with RVP < 40% ( 103 ).…”