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Ventricular pacing dependency after transcatheter aortic valve replacement: a prospective cohort
Sirin Apiyasawat1,2, Mann Chandavimol1, Natcha Soontornmanokati1
1Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Cardiovascular Diagnosis and Therapy
|September 7, 2023
Summary
New ventricular pacing dependency (VpDep) after transcatheter aortic valve replacement (TAVR) occurs in 7.9% of patients. Pre-existing conduction issues like right bundle branch block increase VpDep risk, but it does not impact mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Transcatheter aortic valve replacement (TAVR) is associated with atrioventricular conduction disturbances.
- Not all conduction issues post-TAVR lead to ventricular pacing dependency (VpDep).
Purpose of the Study:
- To determine the incidence, predictors, and outcomes of new VpDep after TAVR.
- To analyze the association between VpDep and all-cause mortality post-TAVR.
Main Methods:
- Prospective analysis of 127 transfemoral TAVR cases (2015-2020).
- Exclusion of patients with prior VpDep; exclusion of 3 patients with prior pacing-dependent CIEDs.
- Multivariate logistic and Cox regression analyses for VpDep and mortality predictors.
Main Results:
- VpDep incidence was 7.9% at 1 month; higher (34.5%) in patients with pre-existing cardiac implantable electronic devices (CIEDs).
- Pre-existing right bundle branch block (OR 21.38) and severe first-degree or Mobitz I atrioventricular block (OR 14.79) were significant predictors of VpDep.
- No significant association found between VpDep and all-cause mortality after a mean follow-up of 25.8 months.
Conclusions:
- Pre-existing conduction abnormalities are significant predictors of VpDep post-TAVR.
- VpDep after TAVR in this cohort did not lead to increased mortality.
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