Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Conduction disturbances requiring permanent pacemaker implantation (PPI) are frequent after transcatheter aortic valve replacement (TAVR).
• Long-term clinical outcomes associated with PPI post-TAVR remain largely uncharacterized.

Purpose of the Study:

• To evaluate the long-term clinical impact of permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR).
• To assess the association between PPI and mortality, heart failure rehospitalization, and changes in left ventricular ejection fraction (LVEF) after TAVR.

Main Methods:

• A multicenter study involving 1,629 patients undergoing TAVR without prior PPI.
• Follow-up data, including clinical status, echocardiography, and pacing parameters, were collected at a median of 4 years post-TAVR.
• Comparative analysis between patients who did and did not require PPI post-TAVR.

Main Results:

• Permanent pacemaker implantation (PPI) was required in 19.8% of patients within 30 days post-TAVR.
• No significant differences in total or cardiovascular mortality were observed between patients with and without PPI.
• Patients with PPI showed higher rates of rehospitalization due to heart failure (22.4% vs. 16.1%) and a combined endpoint of mortality or heart failure rehospitalization (59.6% vs. 51.9%).
• PPI was associated with less improvement in LVEF over time, particularly in patients with pre-existing reduced LVEF.

Conclusions:

• The need for PPI post-TAVR is frequent and associated with increased heart failure rehospitalization risk and diminished LVEF improvement.
• Long-term mortality was not significantly impacted by PPI after TAVR.
• Most patients with new-onset PPI post-TAVR demonstrated some pacing activity during follow-up.