Key result
PPM within 30 days post-TAVR is linked to ~11% greater risk of death and HF hospitalization.
Why the study?
Conduction abnormalities following TAVR often require permanent pacemaker implantation, but outcomes associated with PPM after TAVR at a nationwide level were not well evaluated.
Does permanent pacemaker implantation after TAVR increase the risk of mortality and heart failure hospitalization in patients with aortic stenosis?
Cohort (n=29,422)
Yes
Does permanent pacemaker implantation after TAVR increase the risk of mortality and heart failure hospitalization in patients with aortic stenosis?
Hazard Ratio: 1.11 (95% CI 1.06–1.16)
Permanent pacemaker implantation either at baseline or within 30 days post-TAVR is independently associated with increased mortality and heart failure hospitalization.
PPM after TAVR may signal elevated HF and mortality risk; leaves open whether conduction disease or PPM itself drives outcomes.
BACKGROUND: Conduction abnormalities following transcatheter aortic valve replacement (TAVR) often may require permanent pacemaker implantation (PPM). OBJECTIVE: The purpose of this study was to evaluate outcomes associated with PPM after a TAVR procedure in a large, nationwide-level population. METHODS: Based on the administrative hospital discharge database, the incidence of all-cause death, cardiovascular death, and hospitalization for heart failure (HF) were retrospectively collected, based on the presence or absence of PPM, in the first 30 days following all TAVRs in France from 2010 to 2019. RESULTS: Among 520,662 patients hospitalized for aortic stenosis, 49,201 were treated with TAVR. A total of 29,422 patients had follow-up ≥6 months (median 1.7 years), 22% already had PPM at baseline, and 22% underwent PPM within the first 30 days post-TAVR. Adjusted hazard ratios for the combined risk of all-cause death and hospitalization for HF, during the whole follow-up, were higher in both patients with a previous PPM and in those implanted within 30 days (hazard ratio [95% confidence interval] 1.12 [1.07-1.17] and 1.11 [1.06-1.16], respectively). CONCLUSION: PPM at baseline and within 30 days post-TAVR are independently associated with higher mortality and HF hospitalization during follow-up.
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Clémenty et al. (2021) conducted a cohort in Aortic stenosis (n=29,422). Permanent pacemaker implantation (PPM) within 30 days post-TAVR vs. Absence of PPM was evaluated on Combined risk of all-cause death and hospitalization for heart failure (HR 1.11, 95% CI 1.06-1.16). Permanent pacemaker implantation within 30 days post-TAVR was associated with a higher combined risk of all-cause death and heart failure hospitalization (HR 1.11; 95% CI 1.06-1.16).
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