Single Lead Atrioventricular Sequential Pacing After Transcatheter Aortic Valve Replacement: A Safe and Effective Alternative to Dual Lead Systems

Background Pacemaker implantation following transcatheter aortic valve replacement (TAVR) has been linked to increased mortality. Evidence on the efficacy and safety of single–lead atrioventricular sequential (VDD) pacing in this patient population is currently limited. Purpose We sought to assess whether TAVR patients implanted with VDD had significantly different electrical parameters compared to TAVR patients implanted with dual lead pacemakers (DDD). Moreover, we investigated whether VDD pacing resulted in significantly different acute complications and long–term mortality rates than DDD pacing. Methods We conducted a retrospective analysis on patients implanted either with a VDD or a DDD after TAVR. We compared PM procedural data and electrical parameters at 1 month, at 1 year and at 2–3 years. Acute complications were considered as procedure or device–related complications occurring up to 7 days after PM implant. Long–term mortality included both cardiovascular and all–cause mortality during the follow–up period. Results 111 patients were included in the study, of which 27 VDD (24%) and 84 DDD (76%). All clinical characteristics were homogeneous between the two groups, except for VDD being significantly older than DDD (85.0 [interquartile range, 81.5–88.0] vs. DDD 82 [78.8–85.0] years, p=0.01). PM implantation was performed after a median of 1 [0–2] day following TAVR in VDD and a median of 2 [0–4] days in DDD. The implantation site of the VDD was apical–septal, whereas the implantation site of the DDD was septal. Implant duration was significantly shorter for VDD as compared to DDD (70.0 [60.5–82.5] vs. 85.0 [70.0–103.5] mins, respectively; p=0.02), as well as median fluoroscopy time (5.3 [3.9–6.9] vs. 9.8 [6.7–16.0] minutes; p‹0.001). The electrical parameters during follow–up are summarized in Figure 1. Median follow–up time in the whole cohort was 1120.0 [823.0–1302.0] days (VDD 1034.5 [895.3–1428.5] vs. DDD 1123.5 [796.3–1277.0] days; p=0.87). Mortality analysis was carried out on all VDD and 79 DDD (5 excluded due to missing data). There were no differences among groups regarding periprocedural complications and long–term mortality (Figure 2). Notably, no VDD required upgrading with an atrial lead. Conclusions In this retrospective, single–centre study, VDD pacemakers in post–TAVR patients had similar long–term electrical parameters, acute complications and long–term mortality compared to DDD, while requiring less procedure time.