Timing of pacemaker implantation and survival in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Background Conduction system disorders resulting in the need of permanent pacemaker implantation remains a limitation of TAVI procedures and data on outcomes after permanent pacemakers are conflicting. Objective To investigate the impact of permanent pacemakers implanted either prior to or after TAVI on mortality. Methods This was a post-hoc analysis of our prospective TAVI registry. All TAVI patients, who have been treated between 1.1.2016 to 31.12.2020 were included. The association of permanent pacemakers with patients characteristics was assessed by multiple regression analyses. The primary endpoint was defined as death from any cause. In addition, Kaplan Meier curves for all-cause mortality were calculated. Results Overall, 1114 patients (81+/-5,8y/o, 49,8% female) were included and followed for up to 8 years. Among these, 120 patients (10,8%) had permanent pacemakers prior to the procedure, 153 (13,7%) underwent pacemaker implantation within 30 days of TAVI. On multivariate regression analysis chronic renal failure (p=0.049), Euroscore II (p<0.001), preprocedural Troponin T (p=0,037) and mean aortic valve gradient (p=0,027) were independent predictors of 1-year mortality. On Cox analyses 30 day-,1- and 5-year mortality rates were not different between patients with and without pacemakers implanted after TAVI. However, 5-year mortality rates were significantly higher in patients with preexisting pacemakers (p=0,001). Conclusion Pacemaker implantation after TAVI did not impact short- or long-term mortality in all-comer patients undergoing TAVI for severe symptomatic aortic stenosis. In contrast, previous pacemaker implantation was associated with increased long-term mortality.5-year mortality