Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis of the STS/ACC TVT RegistryTM
Bundle branch and atrioventricular blocks are among the most common complications following transcatheter aortic valve replacement (TAVR), frequently leading to permanent pacemaker (PPM) implantation. Whether PPM placement can be predicted or portend adverse outcomes is unclear.
A retrospective cohort study of patients undergoing TAVR (with no previous PPM) in the US at 229 sites between November 2011 and September 2014 was performed utilizing the STS/ACC TVT RegistryTM. Patients with and without PPM implantation within 30 days post-TAVR were followed up for one year. Linkage to the Centers for Medicare and Medicaid Services data was needed for 30-day and 1-year outcomes. Results from Cox proportional hazards model with multivariable adjustment are reported below.
PPM was required within 30 days of TAVR in 651 of 9,843 (6.6%) patients. Median time to PPM implantation was 3 days. Self-expanding valves, prior conduction defect, larger annulus size and larger prosthesis sizes were associated with higher PPM implantation rates (all p < 0.0001). PPM implantation was associated with longer median hospital stay [7 vs 6 days, p < 0.0001] and intensive care unit stay [55.8 vs 44.5 hours, p < 0.0001]. At 30 days, PPM implantation was not associated with mortality, heart failure admission, a composite of mortality or heart failure admission, stroke or myocardial infarction. However at one year, PPM implantation was associated with increased mortality [24.1% vs 19.6%, HR 1.32 (95% CI 1.08, 1.61), p = 0.007] and a composite of mortality or heart failure admission [37.3% vs 28.5%, HR 1.33 (95% CI 1.13, 1.57), p < 0.001], but not with stroke or myocardial infarction. There was a nonsignificant trend towards higher 1-year heart failure admission in patients with PPM implantation [16.5% vs 12.9%, HR 1.23 (95% CI 0.96, 1.56), p = 0.097].
At one year, PPM implantation was associated with higher adjusted mortality and a composite of mortality or heart failure admission. A better understanding of the pre-and peri-procedural factors involved in PPM implantation may identify interventions for addressing associated adverse outcomes.
Journal of the American College of Cardiology
Fadahunsi, O., Olowoyeye, A., Ukaigwe, A., Li, Z., Vora, A., Vemulapalli, S., Elgin, E., & Donato, A. A. (2016). Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis of the STS/ACC TVT RegistryTM. Journal of the American College of Cardiology, 67 (13 Supplement 9) Retrieved from https://scholarcommons.towerhealth.org/gme_int_med_resident_program_read/251