Key result
Conduction system pacing post-TAVI shows no significant benefit over conventional pacing after adjustment.
Why the study?
Studies comparing conduction system pacing with conventional pacemaker implantation after transcatheter aortic valve implantation remain scarce.
Does conduction system pacing reduce the composite of all-cause death, LVEF decline ≥10%, and worsening of NYHA class III/IV at 1 year compared to conventional right ventricular pacing in patients requiring permanent pacemaker implantation within 30 days after TAVI?
Cohort (n=778)
Yes
Does conduction system pacing reduce the composite of all-cause death, LVEF decline ≥10%, and worsening of NYHA class III/IV at 1 year compared to conventional right ventricular pacing in patients requiring permanent pacemaker implantation within 30 days after TAVI?
In patients requiring pacemaker implantation after TAVI, conduction system pacing was associated with a lower unadjusted rate of death, LVEF decline, or worsening NYHA class at 1 year compared to conventional right ventricular pacing, though this difference was not statistically significant after multivariable adjustment.
Answers are grounded in this paper and cite their sources.
Conduction system pacing shows no adjusted benefit on composite events post-TAVI; hypothesis-generating and requires randomized confirmation.
Background Studies comparing conduction system pacing (CSP) with conventional pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI) remain scarce. Aim To evaluate the 1-year outcomes of patients undergoing CSP versus conventional PM after TAVI. Methods In this prospective, observational, multicentric cohort study, the outcomes of patients undergoing permanent PM implantation were investigated. Patients were enrolled from three centers across Switzerland between February 2011 and June 2022. Results Among 778 patients receiving PM implantation within 30 days after TAVI (mean age 83±7 years, 40% female, self-expanding valves 54%), 85 (11%) underwent CSP. Patients that received CSP had lower prevalence of coronary artery disease (36, 42% vs. 377, 54%, p = 0.04), received more often balloon-valvuloplasty (36, 42% vs 376, 54%, p=0.04). At one year after PM implant, a composite of all-cause death, a LVEF decline ≥ 10%, and worsening of NYHA class III/IV occurred less often in CSP (HR 0.61, 95% CI 0.43-0.88, p = 0.007) but was not significant after adjusting for age, sex, year of TAVI implant as well as several baseline and procedural parameters (aHR 0.72, 95% CI 0.49- 1.05, p = 0.09). A LVEF decline ≥10% occurred numerically less often, yet not statistically different in CSP compared to right ventricular pacing (3, 8% vs. 78, 18%, HR 0.45, 95% CI 0.15-1.35, p=0.16). Conclusions In this prospective multicentric study, patients receiving CSP within 30 days after TAVI had a lower occurrence of a combined endpoint of death, LVEF decline of ≥ 10% or a worsening in NYHA class III/IV at one year compared to conventional right ventricular pacing but not significantly after multivariable adjustment. The findings are subject to potential time-related confounding despite multivariable adjustment.
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Serban et al. (2026) conducted a cohort in Permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI) (n=778). Conduction system pacing (CSP) vs. Conventional right ventricular pacemaker implantation was evaluated on Composite of all-cause death, LVEF decline ≥10%, and worsening of NYHA class III/IV at 1 year (aHR 0.72, 95% CI 0.49-1.05, p=0.09). Conduction system pacing post-TAVI lowered 1-year death, LVEF decline ≥10%, or functional class III/IV worsening vs conventional pacing unadjusted but not after adjustment.
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