Right ventricular pacing burden ≥30% at 1 year post-TAVR pacemaker implantation was associated with an increased risk of death or heart failure (aHR 2.453; 95% CI 1.040-5.786; P=0.040).
Cohort (n=110)
No
Does right ventricular pacing burden ≥30% increase the risk of heart failure readmission and death in patients with post-TAVR permanent pacemaker implantation?
In patients requiring a permanent pacemaker after TAVR, a right ventricular pacing burden ≥30% at 1 year is associated with significantly increased risks of heart failure readmission and death.
Effect estimate: aHR 2.453 (95% CI 1.040-5.786)
p-value: p=0.040
AIMS: Patients who undergo permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) have a worse outcome. The aim of this study was to identify risk factors of worse outcomes in patients with post-TAVR PPM implantation. METHODS AND RESULTS: This is a single-centre, retrospective study of consecutive patients who underwent post-TAVR PPM implantation from 11 March 2011 to 9 November 2019. Clinical outcomes were evaluated by landmark analysis with cut-off at 1 year after the PPM implantation. Of the 1389 patients underwent TAVR during the study duration and a total of 110 patients were included in the final analysis. Right ventricular pacing burden (RVPB) ≥ 30% at 1 year was associated with a higher likelihood of heart failure (HF) readmission adjusted hazard ratio (aHR): 6.333; 95% confidence interval [CI: 1.417-28.311; P = 0.016] and composite endpoint of overall death and/or HF (aHR: 2.453; 95% CI: 1.040-5.786; P = 0.040). The RVPB ≥30% at 1 year was associated with higher atrial fibrillation burden (24.1 ± 40.6% vs. 1.2 ± 5.3%; P = 0.013) and a decrease in left ventricular ejection fraction (-5.0 ± 9.8% vs. + 1.1 ± 7.9%; P = 0.005). The predicting factors of the RVPB ≥30% at 1 year were the presence of RVPB ≥40% at 1 month and the valve implantation depth measured from non-coronary cusp ≥4.0 mm (aHR: 57.808; 95% CI: 12.489-267.584; P < 0.001 and aHR: 6.817; 95% CI: 1.829-25.402; P = 0.004). CONCLUSIONS: The RVPB ≥30% at 1 year was associated with worse outcomes. Clinical benefit of minimal RV pacing algorithms and biventricular pacing needs to be investigated.
Tsushima et al. (Thu,) conducted a cohort in Post-transcatheter aortic valve replacement permanent pacemaker implantation (n=110). Right ventricular pacing burden ≥30% vs. Right ventricular pacing burden <30% was evaluated on Composite endpoint of overall death and/or heart failure (aHR 2.453, 95% CI 1.040-5.786, p=0.040). Right ventricular pacing burden ≥30% at 1 year post-TAVR pacemaker implantation was associated with an increased risk of death or heart failure (aHR 2.453; 95% CI 1.040-5.786; P=0.040).