Aortic valve interventions

Pacemaker dependency after transcatheter aortic valve implantation: incidence, predictors and long-term outcomes

EuroIntervention 2019;15:875-883. DOI: 10.4244/EIJ-D-18-01060

Giuliano Costa
Giuliano Costa1, MD; Paolo Zappulla1, MD; Marco Barbanti1, MD; Arianna Cirasa1, MD; Denise Todaro1, MD; Giulia Rapisarda1, MD; Andrea Picci1, MD; Francesco Platania1, MD; Antonio Tosto1, MD; Angelo Di Grazia1, MD; Carmelo Sgroi1, MD; Corrado Tamburino1, MD, PhD; Valeria Calvi1, MD, PhD
1. Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy

Aims: The aims of this study were to determine the appropriateness of permanent pacemaker implantation (PPI) after TAVI through an analysis of PM dependency at follow-up, and to assess long-term outcomes of patients undergoing PPI after TAVI.

Methods and results: From June 2007 to February 2018, 1,116 consecutive patients without prior PM underwent TAVI in our institution. We assessed the incidence and predictors of PM dependency of patients who underwent PPI within 30 days, and also the six-year outcomes among patients who did not undergo PPI at 30 days. At 30 days, PPI was reported in 145 patients (13.0%). Rates of PM dependency were 35.7%, 35.8% and 33.3% at 1, 6 and 12 months, respectively. Analysing PPI timing, implantation on day 1 was found to be a predictor of PM dependency at six months (OR 20.7 [95% CI: 3.4-126.7]; p=0.001) and 12 months (OR 7.5 [95% CI: 1.4-40.2]; p=0.019). An interaction between PM dependency and the presence of baseline right bundle branch block (RBBB) at six months (pinteraction=0.024) and 12 months (pinteraction=0.028) was reported when PPI was performed on the same day as TAVI. At six years, patients who received a PM at 30 days showed a higher all-cause death rate (KM estimate 41.7% vs 57%; plog-rank=0.034).

Conclusions: Among patients receiving PPI after TAVI, PM dependency rates were about 33-36% at one year. Patients with a baseline RBBB undergoing PPI at day 0 or at day 1 when severe CDs persisted for 24 hours after TAVI, irrespective of baseline CDs, had a higher chance of being PM-dependent at follow-ups. Finally, PPI after TAVI was associated with increased six-year mortality.

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