Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement

Abstract

Transcatheter aortic valve replacement (TAVR) is a standard treatment indicated for severe aortic stenosis in high-risk patients. The objective of this study was to evaluate the incidence of pacemaker dependency after permanent pacemaker implantation (PPI) following TAVR or surgical aortic valve replacement (SAVR) and the risk of mortality at a tertiary center in Korea. In this retrospective study conducted at a single tertiary center, clinical outcomes related to pacemaker dependency were evaluated for patients implanted with pacemakers after TAVR from January 2012 to November 2018 and post-SAVR from January 2005 to May 2015. Investigators reviewed patients’ electrocardiograms and baseline rhythms as well as conduction abnormalities. Pacemaker dependency was defined as a ventricular pacing rate > 90% with an intrinsic rate of <40 bpm during interrogation. Of 511 patients who underwent TAVR for severe AS, 37(7.3%) underwent PPI after a median duration of 6 (3–7) days, whereas pacemakers were implanted after a median interval of 13 (8–28) days post-SAVR in 10 of 663 patients ( P < .001). Pacemaker dependency was observed in 36 (97.3%) patients during 7 days immediately post-TAVR and in 25 (64.9%) patients between 8 and 180 days post-TAVR. Pacemaker dependency occurred after 180 days in 17 (50%) patients with TAVR and in 4 (44.4%) patients with SAVR. Twelve (41.4%) patients were pacemaker-dependent after 365 days post-TAVR. Pacemaker dependency did not differ at 6 months after TAVR vs SAVR. In patients undergoing post-TAVR PPI, 58.6% were not pacemaker-dependent at 1 year after the TAVR procedure.

Risk factors and mortality associated with permanent pacemaker after surgical or transcatheter aortic valve replacement: Early versus late implantation

“…Similarly, another report revealed a prolonged QRS interval (OR = 1.02; 95% CI = 1.01–1.04; p = .005), self‐expandable valves (OR = 7.3; 95% CI = 2.02–26.6; p = .002), and initial procedure years (OR = 4.08, 95% CI = 1.01–15.1; p = .035) to be correlated with need for PPM implantation after 30 days (late) of TAVR procedure 11 . Recent literature also suggests that pacemaker dependency eventually reduces by approximately half within 3 months post‐TAVR procedures 16 . Right ventricular pacing dependency (>40%) has been shown to adversely affect survival in the long term 16 .…”

“…Recent literature also suggests that pacemaker dependency eventually reduces by approximately half within 3 months post‐TAVR procedures 16 . Right ventricular pacing dependency (>40%) has been shown to adversely affect survival in the long term 16 . Conduction defects requiring high‐frequency right ventricle pacing can lead to LV dyssynchrony and increased all‐cause mortality 17 .…”

“…16 Right ventricular pacing dependency (>40%) has been shown to adversely affect survival in the long term. 16 dyssynchrony and increased all-cause mortality. 17 Pacemaker dependency also reduces the ejection fraction secondary to structural changes in patients with no prior history of heart failure.…”