Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement

Background A high burden of right ventricular pacing (RVP) increases the risk of heart failure hospitalization. Data on predictive factors for high burden of RVP in patients with permanent pacemaker implantation (PPI) after Transcatheter Aortic Valve Replacement (TAVR) are limited. Objectives We aimed to identify predictors of high RVP burden in patients with current indications for PPI post-TAVR. Methods We included consecutive patients who underwent PPI after TAVR between 2013 and 2023 at our institution. Dual-chamber pacemakers were programmed with an algorithm favoring spontaneous AV conduction. High burden of RVP was defined as a pacing percentage >20% (>20%VP) at 3- to 12-month follow-up. Results Among 193 patients included, 92 (47.7%) had >20%VP at 3- to 12- month follow up. Male gender (OR=2.48, 95%CI 1.31–4.67), permanent atrial fibrillation (OR=2.49, 95%CI 1.01–6.15), and high degree AV block as the indication for PPI (OR=5.05, 95%CI 2.32–11.0) were independent predictors of >20%VP. A H 2 AS risk score predicting >20%VP was derived, including High Degree AV block (2 points), permanent atrial fibrillation (1 point) and male sex (1 point). A score≥ 3 identified a 68% prevalence of >20%VP. Over a median follow-up of 27.7 months, >20%VP was associated with a higher risk of all-cause mortality or heart failure hospitalization (HR=2.03, 95%CI 1.09–3.81; p=0.03). Conclusion A high RVP burden>20%VP can be anticipated using a readily available pre-PPI risk assessment. The H 2 AS risk-score may assist clinicians in determining the most appropriate ventricular pacing strategy for patients post-TAVR with an indication for PPI.