Ventricular pacing rate and ventricular pacing dependency in patients requiring permanent pacemaker implantation after transcatheter aortic valve replacement

Abstract Background Conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication of Transcatheter Aortic Valve Replacement (TAVR). Recently, it has been suggested that pacing dependency may decrease over time. Purpose To evaluate the dynamic evolution and predictors of adequacy of PPI after TAVR through an analysis of the ventricular pacing rate (VPR) and pacemaker dependency (PD) during the first year after PPI. Methods A retrospective analysis of all patients who underwent TAVR until November 2023 in one high-volume tertiary care center in Portugal was conducted. The VPR of the patients that were submitted to PPI after TAVR was analyzed at 3 distinct moments; during hospitalization, 1 month and 1 year after PPI. PMD was defined using a VPR cut-off of 80%. Patients with previous PPI, indication for PPI pre-TAVR and indication for cardiac resynchronization therapy were excluded. Results Of the 971 patients included, de novo PPI was conducted in 199 cases (implantation rate - 22.2%), on average 4 days after TAVR. VPR analysis showed a bimodal distribution, with rates predominantly over 80% and below 20%, with a reduction in VPR over time (FIGURE 1). During hospitalization, 57.7% of patients had a VPR over 80% and 17.6% had a VPR of less than 20% (median VPR of 99%). At 1 month, 46.7% had a VPR over 80% and 24.7% had a VPR of less than 20% (median VPR of 80%). Finally, at 1 year, only 33% had a VPR over 80% and 27.5% had a VPR of less than 20% (median VPR of 55%). Approximately 30% of the cases were "pacemaker dependent" in all the evaluations and 20% were "never dependent". Previous complete right bundle branch block, occurrence of complete AV block and earlier PPI (especially within the first 24 hours) were significantly correlated with PMD across all VPR evaluations, with complete AV block during TAVR procedure being the sole independent predictive factor (OR 3.638 95% CI: 1.388 - 9.533; p=0.009). Conclusion In a large cohort of P receiving PPI after TAVR, VPR and PD diminished over time during the first year of follow-up. Complete AV block during TAVR was the most powerful predictor of long-term PD.Evolution of VPR over 1 year follow-up