Predictive Factors for Permanent Pacemaker Implantation and Mortality after Transcatheter Aortic Valve Replacement in...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing transcatheter aortic valve replacement (TAVR).
• Limited data exist on predictors of permanent pacemaker implantation (PPI) in TAVR patients with AF.
• Understanding these factors is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To determine the prevalence of AF in TAVR patients.
• To identify predictors of 30-day PPI in this cohort.
• To investigate the association between PPI and 3-year mortality.

Main Methods:

• A historical cohort study included 1,579 patients undergoing TAVR between 2008 and 2022.
• Exclusion criteria included prior aortic valve bioprosthesis or pacemakers.
• Univariate and multivariable analyses assessed 30-day PPI and 3-year mortality.

Main Results:

• Of 1,579 patients, 405 (25.6%) had AF. The 30-day PPI rate was 21.7%.
• Right bundle branch block (RBBB) and CoreValve/Evolut valve type were significant predictors of PPI.
• PPI was not significantly associated with increased 3-year mortality.

Conclusions:

• AF is prevalent in TAVR patients, with high PPI rates.
• Predictors of PPI in AF patients mirror those in sinus rhythm patients, including RBBB and valve type.
• High PPI rates in TAVR patients with AF do not appear to affect long-term mortality.