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Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve

Divyanshu Mohananey1, Yash Jobanputra2, Arnav Kumar2

  • 1From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH. mohanad@ccf.org.

Circulation. Cardiovascular Interventions
|July 13, 2017
PubMed

Insights

Permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) does not increase mortality or stroke risk. However, PPM is linked to reduced recovery of left ventricular ejection fraction post-TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a primary treatment for aortic stenosis in high-risk patients.
  • Conduction abnormalities are common post-TAVR, often necessitating permanent pacemaker (PPM) implantation.
  • The clinical impact of PPM implantation after TAVR remains debated.

Purpose of the Study:

  • To evaluate the effect of PPM implantation on clinical and echocardiographic outcomes after TAVR.
  • To summarize existing data using meta-analysis techniques.
  • To clarify the risks and benefits associated with PPM implantation post-TAVR.

Main Methods:

  • Meta-analysis of relevant studies.
  • Summarized dichotomous variables using Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CIs).
  • Assessed continuous variables using standardized mean difference and 95% CIs; evaluated heterogeneity with Higgins I² statistic.

Main Results:

  • No significant difference in all-cause mortality, cardiovascular mortality, myocardial infarction, or stroke at 30 days and 1 year between patients with and without PPM.
  • Similar rates of all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16) and cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24) at 1 year.
  • Significantly greater improvement in left ventricular ejection fraction observed in patients without PPM (SMD, 0.22; 95% CI, 0.12-0.32).

Conclusions:

  • PPM implantation after TAVR is not associated with increased short- or long-term risks of mortality, stroke, or myocardial infarction.
  • PPM implantation is associated with impaired recovery of left ventricular ejection fraction following TAVR.
  • These findings provide crucial insights into the management of conduction abnormalities after TAVR.
Abstract

Keywords:
aortic valvemeta-analysismyocardial infarctionpermanent pacemakertranscatheter aortic valve replacement

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