Predictors and outcomes of high ventricular pacing burden post transcatheter aortic valve replacement: 5 years of follow-up

INTRODUCTION: Permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) is associated with adverse outcomes. This study aimed to evaluate the long-term outcomes of PPM implantation post-TAVR in patients with high and low ventricular pacing (Vp) burden. METHODS: A single-center, retrospective cohort study of consecutive patients who underwent PPM implantation within 90 days post-TAVR from 2003 to 2022. Patients were divided into two groups based on Vp burden at 1 year: <20 % and ≥ 20 %. The primary outcome was a composite of first cardiovascular hospitalization or all-cause mortality, assessed from 1 to 5 years post-PPM after a 1-year pacing burden assessment. RESULTS: Of 1573 TAVR patients, 229 required a PPM, of whom 199 had complete Vp data at 1 year post-PPM implantation and were included: 84 (42 %) patients with Vp < 20 % and 115 (58 %) patients with Vp ≥ 20 %. Persistent complete atrioventricular block (CAVB) was the most common PPM indication in patients with Vp ≥ 20 % (66 % vs. 11 %, P < 0.001), while transient CAVB was more prevalent in those with Vp < 20 % (48.2 % vs. 11.8 %, P < 0.001). From 1 to 5 years after the post-PPM landmark, patients with Vp ≥ 20 % had higher rates of the composite outcome of cardiac-related first hospitalization or mortality (adjusted HR 3.4; 95 % CI 1.7-6.7; P < 0.001), driven by each of its independent components. They also had a higher incidence of new reduced left ventricular ejection fraction (LVEF<40 %) at 1 year (12 % vs. 1.6 %, P = 0.024). In multivariate analysis, persistent CAVB was the strongest predictor of Vp ≥ 20 % at 1 year (adjusted OR 14.2; 95 % CI 5.3-37.9; P < 0.001). CONCLUSION: 1-year VP ≥20 % post-TAVR PPM implantation was associated with higher cardiac hospitalizations and mortality over 5 years of follow-up.