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Permanent pacemaker implantation after transcatheter aortic valve implantation: impact on late clinical outcomes and

Marina Urena1, John G Webb, Corrado Tamburino

  • 1Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (M.U., E.D., R.D., H.B.R., L.N.-F., F.P., J.R.-C.); St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada (J.G.W., M.B.); Ferrarotto Hospital, University of Catania, Catania, Italy (C.T., M.B., S.I.); Hospital Clínico de Málaga, Universidad de Málaga, Málaga, Spain (A.J.M.-G., J.H.A.B.); St. Michael's Hospital, Toronto University, Toronto, ON, Canada (A.C., H.A.L.); Clínica de Occidente de Cali, Cali, Colombia (A.E.D., L.M.B., A.M.C.); Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (V.S., B.G.d.B.); and Hospital Clinico Universitario de Valladolid, Valladolid, Spain (I.A.-S., J.L.).

Circulation
|December 28, 2013
PubMed

Insights

Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation is common but does not increase mortality. However, new PPI negatively impacts left ventricular function over time.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Limited data exist on the long-term clinical impact of permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).
  • Assessing the outcomes associated with PPI after TAVI is crucial for patient management and risk stratification.

Purpose of the Study:

  • To evaluate the impact of PPI after TAVI on late clinical outcomes in a large patient cohort.
  • To determine the association between early PPI and mortality, rehospitalization, and cardiac function post-TAVI.

Main Methods:

  • A retrospective analysis of 1556 patients undergoing TAVI without prior PPI.
  • Follow-up data collected at a mean of 22±17 months to assess mortality, rehospitalization, and left ventricular ejection fraction (LVEF).
  • Statistical analysis using hazard ratios and regression models to identify predictors of outcomes.

Main Results:

  • 15.4% of patients required PPI within 30 days post-TAVI.
  • No significant association was found between 30-day PPI and all-cause mortality, cardiovascular mortality, or heart failure rehospitalization.
  • A lower rate of unexpected death was observed in patients with PPI (HR 0.31, P=0.023).
  • New PPI was associated with poorer LVEF evolution and was an independent predictor of LVEF decrease at 6-12 months.

Conclusions:

  • While PPI is a frequent complication of TAVI, it does not increase long-term mortality or heart failure rehospitalization.
  • Early PPI may offer a protective effect against unexpected death after TAVI.
  • New PPI negatively affects left ventricular function over time, necessitating further monitoring.
Abstract

Keywords:
aortic stenosisaortic valvedeath, sudden, cardiacheart valvespacemaker, artificial

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