Key result
Pre-TAVR pacemaker implantation shows no association with increased all-cause mortality.
Why the study?
Data regarding the association between pacemaker implantation and mortality following TAVR have been conflicting as the number of long-term pacemaker carriers increases.
Does pacemaker implantation increase all-cause mortality or cardiac re-hospitalization in patients undergoing TAVR with self-expanding prostheses?
Cohort (n=1,779)
Yes
Does pacemaker implantation increase all-cause mortality or cardiac re-hospitalization in patients undergoing TAVR with self-expanding prostheses?
Effect estimate: adj. HR 0.93 (95% CI 0.76-1.13)
p-value: p=0.475
Pacemaker implantation is not associated with increased mortality in patients receiving self-expanding TAVR valves, although post-TAVR pacemakers may increase the risk of cardiac re-hospitalization.
Pre-TAVR pacemaker implantation does not increase mortality after self-expanding TAVR; leaves open post-TAVR effects on cardiac re-hospitalization.
BACKGROUND: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR. AIMS: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis. METHODS: Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up. RESULTS: Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001). CONCLUSIONS: PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.
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Felice et al. (2026) conducted a cohort in Transcatheter aortic valve replacement (n=1,779). Pacemaker implantation vs. No pacemaker was evaluated on All-cause mortality (adj. HR 0.93, 95% CI 0.76-1.13, p=0.475). Pre-TAVR pacemaker implantation was not associated with an increased risk of all-cause mortality in patients undergoing TAVR (adj. HR 0.93; 95% CI 0.76-1.13; p=0.475).
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