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Published on: February 26, 2013
Atrial Fibrillation is Associated with Increased Pacemaker Implantation Rates in the Placement of AoRTic
Angelo B Biviano1, Tamim Nazif1, Jose Dizon1
1Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY.
Insights
Developing atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR) significantly increases pacemaker needs. Patients converting to AF post-TAVR show higher implantation rates and distinct indications compared to those in sinus rhythm.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is linked to adverse outcomes in cardiovascular diseases.
- Data on pacemaker implantation in AF patients undergoing transcatheter aortic valve replacement (TAVR) is limited.
Purpose of the Study:
- To investigate the impact of AF on pacemaker implantation rates and indications in TAVR patients.
- To compare pacemaker use in patients with different heart rhythms (sinus rhythm vs. AF) before and after TAVR.
Main Methods:
- Analysis of 1723 patients without prior pacemakers from the PARTNER trial undergoing TAVR.
- Comparison of pacemaker implantation rates and indications based on baseline and discharge heart rhythm (SR/SR, SR/AF, AF/AF).
Main Results:
- Patients developing AF by discharge (SR/AF) had the highest 30-day (13.7%) and 1-year (17.7%) pacemaker implantation rates.
- Conversion from SR to AF post-TAVR independently predicted increased pacemaker implantation (30-day HR 2.19, 1-year HR 1.91).
- Pacemaker indications varied, with sick sinus syndrome more common in AF groups and AV block in SR groups.
Conclusions:
- Conversion to AF after TAVR is an independent predictor of permanent pacemaker implantation.
- Pacemaker indications in TAVR patients differ based on heart rhythm, with tachy-brady syndrome prevalent in AF patients.
Abstract:
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
