One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

Abstract

Objectives: Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI.Methods: We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted.Results: Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI.Conclusions: Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term. (JTCVS Open 2021;6:41-55)

The Incidence, Predictors, and Mortality Impact of Ventricular Pacing Dependency after Transcatheter Aortic Valve Replacement: A Prospective Cohort

“…Prior literatures calculated the incidence of VpDep based on variable selection criteria. 5 Almost all of them excluded patients who already had PPM even though they were not VpDep.…”

“…1 2 However, conduction disturbance may resolve over time and ventricular pacing dependent (VpDep) may occur only in a certain proportion of patients with PPM. 4 4 5 VpDep could lead ventricular dysfunction 6 and affect the long-term prognosis of patients underwent TAVR. Prior literatures calculated the incidence of VpDep based on variable selection criteria.…”

“…Prior literatures calculated the incidence of VpDep based on variable selection criteria. 5 Almost all of them excluded patients who already had PPM even though they were not VpDep. In the present trial, we studied a cohort of patients underwent TAVR using all types of TAVR devices.…”

Commentary: Take your time!

“…In this issue of JTCVS Open , Ravaux and colleagues 5 provide evidence that a number of patients receiving a PPI for atrioventricular (AV) block have their preoperative rhythm restored after several months. 5 According to this meta-analysis, mean pacing dependency at 1 year was 47.5% (range, 7%-89%). As expected, patients with preoperative right BBB and those receiving self-expandable prostheses had a 2-fold increased risk of requiring PPI.…”

Commentary: Pacemaker dependency after transcatheter aortic valve implantation: Only half as bad?

“…In this new meta-analysis, 4 the authors screened 801 publications and analyzed 23 to determine the incidence of pacemaker dependency at 1 year after TAVI. They confirmed previous reports that found self-expanding TAVIs and preinterventional right bundle branch block were associated with an increased risk of AVB.…”