Contemporary rate of pacemaker implantation in patients discharged after TAVR

Background: In-hospital permanent pacemaker implantation (PPMI) is a frequent and well-known complication of transcatheter aortic valve replacement (TAVR) procedure. The period of monitoring for need for pacing after discharge remains poorly understood. Methods: The National Readmission Database from first six months of calendar year 2016 and 2017 was queried for patient discharged alive after TAVR. All patients with prior pacemakers were excluded. Patients who received pacemaker after discharge (d-PPMI) were compared to a) patients receiving no pacemaker (o-PPMI) or b) patients receiving pacemaker on index admission(i-PPMI) over a 6 month follow-up. Results: Out of 39,993 patients who did not have a prior pacemaker, 4001(10.0%) underwent PPM implantation during index admission (i-PPMI) while over the next 6 months, a further 734 (1.8%) patients underwent the procedure (d-PPMI). For patients receiving PPMI during follow-up post TAVR discharge, the majority (68%) occurred within 14 days. The primary cause of readmission for d-PPMI was heart block in majority of the cases (73%; complete heart block 49%, second degree heart block 4%, bradycardia/other heart block 20%). The d-PPMI group also had a relatively shorter length of stay and a lower comorbidity burden when compared to the i-PPMI group. When compared to the o-PPMI group, the d-PPMI group were more likely to have higher advanced heart block. Conclusions: About one-fifth of pacemakers implanted post TAVR procedures happen during follow-up with a majority of them happening immediately after discharge. Risk stratification at discharge may help to identify patients who undergo PPMI post discharge.