Why the study?
Conduction abnormalities requiring permanent pacemaker implantation remain the most frequent post-TAVI complication, but reliance on pacemaker function varies.
Does a high right-ventricular stimulation rate post-TAVI increase the risk of major adverse cardiovascular events in patients with pre-existing or new permanent pacemakers?
Cohort (n=769)
Yes
Does a high right-ventricular stimulation rate post-TAVI increase the risk of major adverse cardiovascular events in patients with pre-existing or new permanent pacemakers?
Answers are grounded in this paper and cite their sources.
A higher right-ventricular stimulation rate post-TAVI significantly increases the risk of mortality and heart failure hospitalization, emphasizing the need for meticulous, shallower valve implantation depth to minimize pacing dependence.
Aims Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remain the most frequent complication post-transcatheter aortic valve implantation (TAVI), yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year major adverse cardiovascular events (MACE) (all-cause mortality and heart failure hospitalization). Methods and results This retrospective cohort study of patients undergoing TAVI in two high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into two groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. Of 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI is associated with a two-fold increased risk for MACE [1.97 (1.20, 3.25), P = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), P=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), P = 0.047]. Conclusion Greater RV-stimulation rates post-TAVI correlate with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
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Dykun et al. (2023) conducted a cohort in Patients undergoing transcatheter aortic valve implantation (TAVI) with pre-existing or new permanent pacemakers (n=769). High right-ventricular (RV) stimulation rate (>10%) post-TAVI vs. Low right-ventricular (RV) stimulation rate (≤10%) post-TAVI was evaluated on 1-year major adverse cardiovascular events (MACE), a composite of all-cause mortality and heart failure hospitalization (HR 1.97, 95% CI 1.20-3.25, p=0.008).
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