Predictors of pacemaker dependency in patients implanted with a pacemaker after Transaortic valve replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Complete atrioventricular block is a frequent complication after Transcatheter Aortic Valve Replacement (TAVR).
• Pacemaker (PM) dependence after TAVR is a significant concern, with higher ventricular pacing (VP) potentially linked to poorer outcomes in other clinical contexts.

Purpose of the Study:

• To identify predictors of pacemaker dependence following TAVR.
• To investigate factors associated with high and very high percentages of ventricular pacing (VP) and overall survival post-TAVR.

Main Methods:

• Retrospective analysis of 96 consecutive patients who received a pacemaker post-TAVR (Core-Valve).
• Evaluation of patient demographics, pre-TAVR risk scores, pacing indications, and follow-up data including PM dependency and survival.

Main Results:

• Female sex and indication for complete AV block were independent predictors of PM dependency.
• A high percentage of ventricular pacing (VP > 50% or > 85%) did not significantly influence mortality.
• The overall survival was 62.7 months, with pre-TAVR logistic EuroSCORE being the sole independent predictor of mortality.

Conclusions:

• Female sex and complete AV block as the indication for PM implantation are key predictors of pacemaker dependence after TAVR.
• In patients with preserved LVEF, high ventricular pacing percentages do not appear to affect prognosis.