Key result
Leadless pacemaker implantation after TAVR shows similar high success and complication rates to non-TAVR patients.
Why the study?
Conduction system impairment is a common complication of TAVR, but data regarding the efficacy and safety of leadless pacing after TAVR remain sparse.
Does leadless pacemaker implantation offer similar safety and efficacy in frail patients requiring pacing post-TAVR compared to patients with other pacing indications?
Cohort (n=257)
Yes
Does leadless pacemaker implantation offer similar safety and efficacy in frail patients requiring pacing post-TAVR compared to patients with other pacing indications?
Leadless pacemaker implantation is a safe, feasible, and effective option for frail, elderly patients who develop bradyarrhythmias post-TAVR, demonstrating high procedural success and low complication rates comparable to a non-TAVR cohort.
Supports leadless pacing post-TAVR; extends observational data but remains hypothesis-generating pending randomized confirmation.
BackgroundImpairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. Leadless pacing (LP) may be a suitable option in this frail population, but the available scientific data concerning efficacy and safety of leadless pacing after TAVR is sparse. The purpose of the analysis was to evaluate the efficacy and safety of leadless pacemaker implantation in patients with relevant bradycardias after TAVR compared to other indications.MethodsConsecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters and follow-up data was collected.Results257 consecutive patients having undergone LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group) while the remaining 231 patients were in the population without previous TAVR (non-TAVR group). Mean implantation duration (56 ± 22 min in the TAVR versus 48 ± 20 min in the non-TAVR group; P=NS) and implantation success rate (100% in the TAVR vs 98.7% in the non-TAVR group; P=NS) were similar between the two cohorts. There were no significant differences in pacing parameters (sensing, impedance and threshold, respectively) between the two groups both at implantation and during follow-up. A total of eight major periprocedural complications (3.1% of patients in total, 3.8% in the TAVR vs 3.0% in non-TAVR group; P=NS) occurred within 30 days without significant difference between the two groups.ConclusionsLP implantation appears to be safe and effective in patients after TAVR and therefore a suitable option in this often old and frail population.
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Jelisejevas et al. (2023) conducted a cohort in Bradyarrhythmias requiring pacing (post-TAVR vs other indications) (n=257). Leadless pacemaker implantation post-TAVR vs. Leadless pacemaker implantation for indications other than TAVR was evaluated on Implantation success rate (p=NS). Leadless pacemaker implantation after TAVR demonstrated a 100% success rate and a 3.8% 30-day major complication rate, showing no significant difference compared to non-TAVR patients.
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