Prior or new permanent pacemakers after TAVI were independently associated with higher 1-year all-cause mortality compared to no pacemaker (prior PPM HR 1.31; 95% CI 1.08-1.60; P=0.006).
Cohort (n=2,531)
Yes
Does chronic pacing (prior or new permanent pacemaker) or LBBB worsen clinical outcomes and LVEF recovery in patients undergoing TAVI?
Prior or new permanent pacemakers and chronic LBBB are associated with worsened 1-year mortality and reduced LVEF recovery after TAVI, likely due to ventricular dyssynchrony from chronic right ventricular pacing.
Effect estimate: HR 1.31 (95% CI 1.08 to 1.60)
Absolute Event Rate: 27.4% vs 20%
p-value: p=0.006
OBJECTIVE: Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes. METHODS AND RESULTS: Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p88%). CONCLUSIONS: In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings. TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT00530894).
Dizon et al. (Mon,) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=2,531). Prior or new permanent pacemaker (PPM) vs. No PPM was evaluated on 1-year all-cause mortality (HR 1.31, 95% CI 1.08 to 1.60, p=0.006). Prior or new permanent pacemakers after TAVI were independently associated with higher 1-year all-cause mortality compared to no pacemaker (prior PPM HR 1.31; 95% CI 1.08-1.60; P=0.006).