Key result
Conversion to atrial fibrillation by discharge after TAVR was associated with increased permanent pacemaker implantation at 30 days compared to maintaining sinus rhythm (HR 2.19; 95% CI 1.23-3.93).
Why the study?
Does atrial fibrillation increase the rate of permanent pacemaker implantation in patients undergoing TAVR?
Cohort (n=1,723)
Does atrial fibrillation increase the rate of permanent pacemaker implantation in patients undergoing TAVR?
Hazard Ratio: 2.19 (95% CI 1.23–3.93)
Absolute Event Rate: 13.7% vs 5.4%
p-value: p=0.008
New-onset atrial fibrillation after TAVR is an independent predictor of permanent pacemaker implantation, often driven by sick sinus syndrome rather than AV block.
New-onset AF after TAVR was associated with higher pacemaker rates; leaves open whether rhythm strategies reduce pacing need.
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
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Biviano et al. (2017) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=1,723). Conversion from sinus rhythm to atrial fibrillation by discharge (SR/AF) vs. Sinus rhythm at baseline and discharge (SR/SR) was evaluated on Permanent pacemaker implantation at 30 days (HR 2.19, 95% CI 1.23-3.93, p=0.008). Conversion to atrial fibrillation by discharge after TAVR was associated with increased permanent pacemaker implantation at 30 days compared to maintaining sinus rhythm (HR 2.19; 95% CI 1.23-3.93).
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