Self-expandable valves were associated with higher in-hospital permanent pacemaker implantation rates than balloon-expandable valves after TAVI (18.2% vs. 9.8%; OR 2.03; 95% CI 1.88-2.20; p<0.001).
Observational (n=23,679)
Yes
What are the incidence, temporal trends, and predictors of in-hospital permanent pacemaker implantation following TAVI?
Permanent pacemaker implantation remains a common complication after TAVI, with rates increasing over time and higher risks associated with self-expandable valves, larger valve sizes, and current-generation balloon-expandable valves.
Effect estimate: OR 2.03 (95% CI 1.88-2.20)
Absolute Event Rate: 18.2% vs 9.8%
p-value: p=<0.001
Abstract Background Conduction abnormalities requiring permanent pacemaker (PPM) implantation are a common complication in patients undergoing transcatheter aortic valve implantation (TAVI). Existing literature, including studies based on large databases and meta-analyses, typically reports data up to 2019. Since then, new valve designs have been introduced, and guidelines regarding PPM implantation have changed. Purpose This study aims to evaluate the incidence, temporal trends, and predictors for PPM implantation following TAVI during hospitalization, using a large, contemporary database. Methods The CENTER2-study is a patient-level database that encompasses 25,771 patients who underwent TAVI. Only patients with documented pacemaker status were included. Logistic regression analysis was performed to identify predictors of PPM implantation. Results A total of 23,679 patients (56% female) who underwent TAVI between 2007 and 2022 were included in the study. In-hospital PPM implantation was observed in 3,507 patients (14.8%). The rates of in-hospital PPM implantation increased over time when assessed in 4-year intervals, rising from 15.1% during 2007-2010 to 16.3% during 2019-2022 (ptrend0.001). The implantation of self-expandable valves (SEVs) was associated with higher in-hospital PPM implantation rates compared to balloon-expandable valves (BEVs) (18.2% vs. 9.8%; OR: 2.03; 95% CI: 1.88-2.20; p0.001). The rate of in-hospital PPM implantation decreased in current-generation SEVs compared to older-generation SEVs (20.3% vs. 17.3%; OR: 0.82; 95% CI: 0.75–0.90; p0.001). However, current-generation BEVs were associated with a higher in-hospital PPM implantation rate compared to older-generation BEVs (6.4% vs. 13.1%; OR: 2.18; 95% CI: 1.89-2.50; p0.001). The in-hospital PPM implantation rate increased with larger valve sizes, ranging from 7.4% for 20 up to 23 mm valves to 23.9% for 34 mm valves (p0.001; Fig. 1). Predictors of in-hospital PPM implantation after TAVI included the implantation of a self-expandable valve, valve size, postdilatation, and age (Fig. 2). Conclusion This study demonstrates that PPM implantation remains a common and increasingly prevalent complication in patients undergoing TAVI. The likelihood of PPM implantation increases with valve size. Notably, the in-hospital PPM implantation for current-generation BE valves is twice that of older-generation valves. Future research should investigate the underlying causes of the increased PPM implantation rate associated with current-generation BE valves.PPM by valve size category Predictors for PPM after TAVI
Broeze et al. (Sat,) conducted a observational in Transcatheter aortic valve implantation (TAVI) (n=23,679). Self-expandable valves (SEVs) vs. Balloon-expandable valves (BEVs) was evaluated on In-hospital permanent pacemaker (PPM) implantation (OR 2.03, 95% CI 1.88-2.20, p=<0.001). Self-expandable valves were associated with higher in-hospital permanent pacemaker implantation rates than balloon-expandable valves after TAVI (18.2% vs. 9.8%; OR 2.03; 95% CI 1.88-2.20; p<0.001).