Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis in high-risk individuals.
• Permanent pacemaker implantation (PPI) is a known complication following TAVR and surgical aortic valve replacement (SAVR).
• Understanding pacemaker dependency post-TAVR is crucial for patient management and long-term outcomes.

Purpose of the Study:

• To assess the incidence of pacemaker dependency after PPI in patients who underwent TAVR versus SAVR.
• To evaluate the risk of mortality associated with pacemaker dependency following these procedures.
• To analyze the temporal trends of pacemaker dependency in the post-TAVR population.

Main Methods:

• Retrospective study at a single tertiary center analyzing patients who received PPI after TAVR (Jan 2012-Nov 2018) and SAVR (Jan 2005-May 2015).
• Pacemaker dependency defined as ventricular pacing rate >90% with intrinsic rate <40 bpm during interrogation.
• Review of electrocardiograms, baseline rhythms, and conduction abnormalities.

Main Results:

• 37 (7.3%) of 511 TAVR patients and 10 (1.5%) of 663 SAVR patients required PPI (P < .001).
• Pacemaker dependency was high initially post-TAVR (97.3% within 7 days) but decreased to 41.4% at 1 year.
• Pacemaker dependency rates at 6 months did not significantly differ between TAVR and SAVR groups (50% vs 44.4%).

Conclusions:

• Pacemaker dependency after TAVR is common initially but tends to decrease over the first year.
• The long-term pacemaker dependency rates after TAVR are comparable to those after SAVR.
• Further research is needed to explore the risk of mortality associated with pacemaker dependency post-TAVR.