Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Chamandi, Chekrallah; Barbanti, Marco; Muñoz-García, Antonio J.; Latib, Azeem; Nombela‐Franco, Luis; Gutiérrez-Ibanez, Enrique; Veiga‐Fernández, Gabriela; Cheema, Asim N.; Cruz-González, Ignacio; Serra, Violeta; Tamburino, Corrado; Mangieri, Antonio; Colombo, Antonio; Jiménez‐Quevedo, Pilar; Elı́zaga, Jaime; Laughlin, Gerard; Lee, Dae Hyun; Blanco, Bruno García del; Rodríguez‐Gabella, Tania; Marsal, Josep Ramón; Côté, Mélanie; Philippon, François; Rodés‐Cabau, Josep

doi:10.1016/j.jcin.2017.10.032

Cited by 138 publications

(106 citation statements)

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“…Overall 13.1% of patients undergoing TAVR received a new PPM, a rate that is comparable to other studies which have shown PPM implantation rates ranging from 6% to 20% . In particular, a prior study of PPM implantation after TAVR with the Sapien 3 valve demonstrated that 14.6% required subsequent PPM and a large study of 1,629 patients found a 19.8% rate of PPM implantation after TAVR …”

Section: Discussionsupporting

confidence: 72%

“…In evaluation of pacing requirement, Chamandi et al. noted 86% of all patients were paced > 1% of the time with 51% paced at least 40% of the time . In our study, 78.8% were paced > 1% of the time and 63.5% paced at least 40% of the time.…”

Section: Discussionsupporting

confidence: 48%

“…In Overall 13.1% of patients undergoing TAVR received a new PPM, a rate that is comparable to other studies which have shown PPM implantation rates ranging from 6% to 20%. [8][9][10] In particular, a prior study of PPM implantation after TAVR with the Sapien 3 valve demonstrated that 14.6% required subsequent PPM and a large study of 1,629 patients found a 19.8% rate of PPM implantation after TAVR. 10,11 Our rate of 40.3% dependency at first follow-up post-TAVR from all patients who received PPMs is similar to a prior study by Schernthaner et al who reported a dependency rate of 37% using a definition of intrinsic rate less than 30 beats/min.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] In particular, a prior study of PPM implantation after TAVR with the Sapien 3 valve demonstrated that 14.6% required subsequent PPM and a large study of 1,629 patients found a 19.8% rate of PPM implantation after TAVR. 10,11 Our rate of 40.3% dependency at first follow-up post-TAVR from all patients who received PPMs is similar to a prior study by Schernthaner et al who reported a dependency rate of 37% using a definition of intrinsic rate less than 30 beats/min. 9 In fact, when including two additional patients in their study with rates between 30 and 40 beats/min, the dependency rate increased to 43%.…”

Section: Discussionmentioning

confidence: 99%

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Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

Kaplan

Yadlapati

Cantey

et al. 2019

Pacing Clinical Electrophis

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Background Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high‐grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long‐term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high‐grade or complete AV block after TAVR who remain dependent on the PPM in follow‐up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon‐expandable, 18.1% self‐expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow‐up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self‐expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow‐up (< 30 days). The use of self‐expanding valves and PBD are associated with a markedly increased risk of PPM dependency.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

Kaplan

Yadlapati

Cantey

et al. 2019

Pacing Clinical Electrophis

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show abstract

“…Moreover, the deleterious effects of LBBB on left ventricular ejection fraction (LVEF) and major cardiovascular events after TAVR have previously been shown 9 . In a recent study of 1629 patients undergoing TAVR, it was demonstrated that patients who required permanent PMs were at increased risk for heart failure hospitalization (HFH) and reduced LVEF improvement compared with patients without PMs 10 . Importantly, this effect was more pronounced in patients with reduced LVEF pre‐TAVR.…”

mentioning

confidence: 99%

The search for physiologic pacing post‐TAVR

Cano

Vijayaraman

2020

Cardiovasc electrophysiol

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Long-term Outcomes Associated With Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement

et al. 2021

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IMPORTANCE Prior studies investigating the long-term clinical outcomes of patients who have undergone permanent pacemaker implantation after aortic valve replacement reported conflicting results.OBJECTIVE To investigate long-term outcomes after primary surgical aortic valve replacement among patients who underwent postoperative permanent pacemaker implantation. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included all patients who underwent surgical aortic valve replacement in Sweden from 1997 to 2018. All patients who underwent primary surgical aortic valve replacement in Sweden and survived the first 30 days after surgical treatment were included. Patients who underwent preoperative permanent pacemaker implantation, concomitant surgical treatment for another valve, or emergency surgical treatment were excluded.Patients who underwent concomitant coronary artery bypass grafting or surgical treatment of the ascending aorta were included. Follow-up data were complete for all patients. Data were analyzed from October through December 2020.EXPOSURES Patients underwent implantation of a permanent pacemaker or implantable cardioverter defibrillator within 30 days after aortic valve replacement. MAIN OUTCOMES AND MEASURESThe primary outcome was all-cause mortality. RESULTS Among 24 983 patients who underwent surgical aortic valve replacement, 849 patients (3.4%) underwent permanent pacemaker implantation within 30 days after surgical treatment and 24 134 patients (96.6%) did not receive pacemakers in that time. The mean (SD) age of the total study population was 69.7 (10.8) years, and 9209 patients were women (36.9%). The mean (SD) and maximum follow-up periods were 7.3 (5.0) years and 22.0 years, respectively. At 10 years and 20 years after surgical treatment, the Kaplan-Meier estimated survival rates were 52.8% and 18.0% in the pacemaker group, respectively, and 57.5% and 19.6% in the nonpacemaker group, respectively. All-cause mortality was statistically significantly increased in the pacemaker group compared with the nonpacemaker group (hazard ratio [HR], 1.14; 95% CI, 1.01-1.29; P = .03), and so was risk of heart failure hospitalization (HR, 1.58; 95% CI, 1.31-1.89; P < .001). No statistically significant increase was found in the risk of endocarditis in the pacemaker group. CONCLUSIONS AND RELEVANCEThis study found that there were increased risks of all-cause mortality and heart failure hospitalization among patients who underwent permanent pacemaker implantation after surgical aortic valve replacement, suggesting that these risks are important considerations, especially in an era when transcatheter aortic valve replacement is used in younger patients at lower risk of adverse surgical outcomes. These findings further suggest that future (continued) Key Points Question Is permanent pacemaker implantation after aortic valve replacement associated with long-term adverse clinical outcomes? Findings In this cohort study of 24 983 patients who underwent surgical aortic valve replacement, increased risks of death a...

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Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Abstract: The need for PPI post-TAVR was frequent and associated with an increased risk of heart failure rehospitalization and lack of LVEF improvement, but not mortality, after a median follow-up of 4 years. Most patients with new PPI post-TAVR exhibited some degree of pacing activity at follow-up.

Cited by 138 publications

References 42 publications

Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

The search for physiologic pacing post‐TAVR

Long-term Outcomes Associated With Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement

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