One-year Outcomes of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: CONDUCT Registry:...

The occurrence of new conduction abnormalities necessitating permanent pacemaker implantation (PPI) is a complication of transcatheter aortic valve replacement (TAVR). Previous studies have shown inconsistent results about the clinical impact of new PPI after TAVR.

CONDUCT was a prospective observational registry that enrolled 295 patients undergoing TAVR at four European centres. The primary goal of this registry was to compare 1-year clinical outcomes in TAVR patients with or without PPI, using one-to-four propensity score matched (PSM) analysis. It also assessed major adverse cardiac events (MACE) in patients undergoing right ventricular pacing after PPI.

Out of 160 PSM patients, 36 underwent PPI and the other 124 had no PPI within 30 days post-TAVR. The median age of the patients was 80 years, with more men (80.6% and 84.7% in patients with and without PPI, respectively) and similar EuroSCORE II and Society of Thoracic Surgeons scores. Patients with PPI had higher diabetes prevalence (p=0.055) and lower left ventricular ejection fraction percentages (p=0.034), but higher systolic pulmonary artery pressure (p=0.013) than those without PPI. However, these differences diminished after PSM. At 1 year, PPI patients had a nonsignificant but slightly higher incidence of MACE (22.2% versus 13.7%; p=0.216) (HR 1.63; 95% CI [0.72-3.71]) driven by increased heart failure (11.1% versus 2.4%; p=0.046) (HR 5.05; 95% CI [1.09-23.4]). Freedom from all-cause mortality, cardiovascular death, stroke and endocarditis at 1-year follow-up was comparable between groups.

Despite a higher incidence of congestive heart failure rehospitalisation in patients undergoing PPI, 1-year clinical outcomes were similar in both groups.