Key result
Pre-existing CIEDs linked to ~40% higher 3-year all-cause mortality post-TAVR.
Why the study?
Does the presence of pre-existing CIEDs increase all-cause mortality in patients undergoing TAVR?
Cohort (n=1,334)
Yes
Does the presence of pre-existing CIEDs increase all-cause mortality in patients undergoing TAVR?
Effect estimate: HR 1.4 (95% CI 1.2-1.7)
p-value: p=<0.001
Pre-existing ICDs and pacemakers implanted for AV block are associated with increased 3-year mortality following TAVR, whereas pacemakers for sick sinus syndrome have outcomes comparable to patients without devices.
Pre-existing CIEDs associated with higher mortality; leaves open confounding versus independent prognostic effect.
BACKGROUND: Previous studies reported increased mortality and rehospitalization rates in patients undergoing transcatheter aortic valve replacement (TAVR) with prior pacemaker (PM) therapy. However, the impact of different pre-existing cardiac implantable electronic devices (CIEDs), including PM and implantable cardioverter-defibrillators (ICD) and their implications on clinical outcomes after TAVR remains unclear. OBJECTIVES: This multicenter, retrospective study aimed to evaluate the association between pre-existing CIEDs and clinical outcomes after TAVR. METHODS: We analyzed data from 1,334 patients who underwent TAVR at three German tertiary care centers. Patients with pre-existing CIEDs (PM, n = 358 and ICD, n = 58) were compared with patients without a CIED (n = 918). PM patients were further stratified by indication (sick sinus syndrome (SSS) vs. atrioventricular block (AVB)). Primary endpoint was all-cause mortality at 3 years. Propensity score matching (PSM) was conducted as a sensitivity analysis for ICD patients, and a subgroup analysis was performed in patients with reduced left ventricular ejection fraction (LVEF) < 50%. RESULTS: In the overall cohort, patients with pre-existing CIEDs had higher 3-year mortality rates (no device: 28.5% vs. PM: 35.8% vs. ICD: 50.0%; p < 0.001). Patients with PM implanted for AVB exhibited significantly higher mortality than those with PM for SSS (39.8% vs. 29.2%; log-rank p = 0.030), despite comparable baseline characteristics. In PSM cohort, mortality differences were attenuated but persisted (ICD: 52.1%, PM-AVB: 45.8%, no device: 31.0%, PM-SSS: 31.3%; log-rank p = 0.045). In patients with reduced LVEF < 50% (n = 332), intergroup mortality differences were no longer statistically significant (log-rank p = 0.243). CONCLUSION: Pre-existing CIEDs, particularly ICDs and PMs implanted for AVB, were associated with increased mid-term mortality following TAVR. These differences were no longer evident in patients with reduced LVEF. Notably, patients with PMs for SSS had outcomes comparable to those without a CIED.
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Basha et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis undergoing TAVR (n=1,334). Pre-existing cardiac implantable electronic devices (CIED) vs. No pre-existing CIED was evaluated on 3-year all-cause mortality (HR 1.4, 95% CI 1.2-1.7, p=<0.001). Pre-existing cardiac implantable electronic devices were associated with a significantly increased risk of 3-year all-cause mortality (HR 1.4) following TAVR compared to patients without a device.
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