Pre-existing permanent pacemaker before TAVI was associated with higher mortality compared to no pacemaker (RR 1.43; 95% CI 1.26-1.62; P<0.0001), whereas new pacemaker implantation was not.
Meta-Analysis (n=40,016)
Does pre-existing or new permanent pacemaker implantation affect mortality in patients undergoing TAVI?
Pre-existing permanent pacemaker, but not newly implanted pacemaker, is associated with higher mid-term mortality after TAVI, particularly with the transapical approach.
Effect estimate: RR 1.43 (95% CI 1.26-1.62)
p-value: p=< 0.0001
BACKGROUND: Previous implantation of a permanent pacemaker (PPM) is common among patients undergoing transcatheter aortic valve implantation (TAVI). Moreover, onset of conduction disturbances needing new PPM implantation after TAVI is frequent. The interplay of pre-existing and new-PPM on mortality after TAVI remains controversial. METHODS: We performed a systematic review and study-level meta-analysis on the influence of PPM on mortality after TAVI. Patients were divided into 3 groups: pre-existing PPM, new-PPM (implantation within 30 days after TAVI) and no-PPM (without PPM up to 30 days after TAVI). Outcomes were compared using pairwise and network meta-analysis. RESULTS: A total of 28 studies including 40,016 subjects were eligible. Patients of the no-PPM group had a lower mortality outcome compared to the rest of the study population (relative risk RR 0.76, 95% confidence interval CI 0.68-0.85, P < 0.0001) at median follow up of 16.3 months. In particular, patients with a pre-existing PPM (RR 1.43, 95% CI 1.26-1.62, P < 0.0001), but not those with a newly implanted PPM (RR 1.08, 95% CI 0.99-1.18, P = 0.10), had a significantly higher mortality compared to patients of the no-PPM group. Moreover, meta-regression analysis showed that the transapical approach rate had a detrimental interaction with pre-existing PPM on mortality (P = 0.03). CONCLUSION: Compared to patients without PPM, those with a pre-existing PPM before TAVI had higher mortality, in particular if treated by the transapical approach. New-PPM implantation did not have a negative relation on mid-term outcome.
Ueshima et al. (Wed,) conducted a meta-analysis in Patients undergoing transcatheter aortic valve implantation (TAVI) (n=40,016). Pre-existing or new permanent pacemaker (PPM) vs. No permanent pacemaker (no-PPM) was evaluated on Mortality (RR 1.43, 95% CI 1.26-1.62, p=< 0.0001). Pre-existing permanent pacemaker before TAVI was associated with higher mortality compared to no pacemaker (RR 1.43; 95% CI 1.26-1.62; P<0.0001), whereas new pacemaker implantation was not.