Key result
Pre-existing pacemakers predict worse 5-year survival in men and post-procedural implants predict 30-day mortality in women.
Why the study?
Sex-specific differences regarding the prognostic impact of permanent pacemaker implantation after TAVI remain largely unexplored.
Does pacemaker status (pre-existing or new post-procedural) affect short- and long-term mortality differently in men and women after TAVI?
Cohort (n=1,114)
Does pacemaker status (pre-existing or new post-procedural) affect short- and long-term mortality differently in men and women after TAVI?
p-value: p=<0.001 (men), 0.572 (women)
Pacemaker status in TAVI patients carries sex-specific prognostic implications, with new pacemakers increasing 30-day mortality risk in women and pre-existing pacemakers reducing 5-year survival in men.
Sex-specific PM-mortality associations after TAVI warrant cautious sex-stratified risk assessment; leaves open whether targeted strategies alter prognosis.
BACKGROUND: Sex-specific differences regarding the prognostic impact of permanent pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI) remain largely unexplored. OBJECTIVES: To investigate sex-specific associations between pre-existing and new post-procedural PM implantation and short- and long-term mortality after TAVI. METHODS: This post hoc analysis of a prospective registry included consecutive patients who underwent TAVI between 2016 and 2020. Patients were stratified by sex and assigned to three groups: no PM, pre-existing PM (pre-PM) and PM implantation within 30 days of TAVI (post-PM). The primary endpoint was 5-year all-cause mortality; the secondary endpoint was 30-day mortality. Sex-stratified multivariable proportional hazards models and Kaplan-Meier analyses were performed. RESULTS: Among 1114 patients (81 ± 5 years, 49.8% female), women more frequently had no PM (80.2% vs. 70.8%, p < 0.001) and less often had a pre-existing PM (7.0% vs. 14.5%, p < 0.001). Post-PM rates were similar between sexes (12.8% vs. 14.7%, p = 0.172). Thirty-day survival differed by PM status only in women, with worse outcomes in the post-PM group (log-rank p = 0.033), whereas no difference was observed in men (p = 0.542). Five-year survival did not differ by PM status among women (p = 0.572) but differed significantly among men (p < 0.001), with the lowest survival in men with pre-PM. CONCLUSION: Post-procedural PM implantation was associated with higher 30-day mortality in women, whereas pre-existing PM predicted reduced 5-year survival in men, supporting sex-specific risk assessment before and after TAVI.
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Veraar et al. (2026) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=1,114). Permanent pacemaker (PM) implantation (pre-existing or post-procedural) vs. No pacemaker was evaluated on 5-year all-cause mortality (p=<0.001 (men), 0.572 (women)). Pre-existing pacemaker predicted reduced 5-year survival in men (p<0.001), whereas post-procedural pacemaker implantation was associated with higher 30-day mortality in women (p=0.033).
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