Permanent pacemaker implantation within 30 days after TAVI was not associated with all-cause mortality (HR 0.98; 95% CI 0.74-1.30; P=0.871) after a mean follow-up of 22 months.
Cohort (n=1,556)
Does permanent pacemaker implantation within 30 days after transcatheter aortic valve implantation affect late mortality and heart failure outcomes in patients undergoing TAVI?
Permanent pacemaker implantation after TAVI does not increase long-term mortality or heart failure hospitalization, and may protect against sudden death, despite a negative impact on left ventricular ejection fraction.
Hazard Ratio: 0.98 (95% CI 0.74–1.3)
p-value: p=0.871
BACKGROUND: Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. METHODS AND RESULTS: A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74-1.30; P=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56-1.17; P=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77-1.30; P=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11-0.85; P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (P=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6- to 12-month follow-up (estimated coefficient, -2.26; 95% confidence interval, -4.07 to -0.44; P=0.013; R(2)=0.121). CONCLUSIONS: The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
Ureña et al. (2013) conducted a cohort in Transcatheter aortic valve implantation (n=1,556). Permanent pacemaker implantation (PPI) within 30 days vs. No 30-day PPI was evaluated on All-cause mortality (HR 0.98, 95% CI 0.74-1.30, p=0.871). Permanent pacemaker implantation within 30 days after TAVI was not associated with all-cause mortality (HR 0.98; 95% CI 0.74-1.30; P=0.871) after a mean follow-up of 22 months.