August 10, 2015Heart131 citations
Chronic pacing and adverse outcomes after transcatheter aortic valve implantation
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Resultado clave
Prior or new permanent pacemakers after TAVI were independently associated with higher 1-year all-cause mortality compared to no pacemaker (prior PPM HR 1.31; 95% CI 1.08-1.60; P=0.006).
Diseño del estudio
Tipo
Cohort (n=2,531)
Multicéntrico
Sí
PICO estructurado
Does chronic pacing (prior or new permanent pacemaker) or LBBB worsen clinical outcomes and LVEF recovery in patients undergoing TAVI?
P
Población
2,531 patients undergoing transcatheter aortic valve implantation (TAVI) in the PARTNER trial and registries
I
Intervención
Prior permanent pacemaker (PPM) (n=586), new PPM (n=173), or left bundle branch block (LBBB) without PPM (n=160)
C
Comparador
No permanent pacemaker (n=1612)
O
Resultado
1-year all-cause mortalityhard clinical
Prior or new permanent pacemakers and chronic LBBB are associated with worsened 1-year mortality and reduced LVEF recovery after TAVI, likely due to ventricular dyssynchrony from chronic right ventricular pacing.
Resultado numérico
Estimación del efecto: HR 1.31 (95% CI 1.08 to 1.60)
Tasa de eventos absoluta: 27.4% vs 20%
valor p: p=0.006
Resumen
OBJECTIVE: Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes. METHODS AND RESULTS: Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p88%). CONCLUSIONS: In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings. TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT00530894).