Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation.
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Bruno Francesco, Munoz Pousa Isabel, Saia Francesco, Vaira Matteo Pio, Baldi Enrico, Leone Pier Pasquale, Cabanas-Grandio Pilar, Corcione Nicola, Spinoni Enrico Guido, Annibali Gianmarco, Russo Caterina, Ziacchi Matteo, Caruzzo Carlo Alberto, Ferlini Marco, Lanzillo Giuseppe, De Filippo Ovidio, Dusi Veronica, Gallone Guglielmo, Castagno Davide, Patti Giuseppe, La Torre Michele, Musumeci Giuseppe, Giordano Arturo, Stefanini Giulio, Salizzoni Stefano, Conrotto Federico, Rinaldi Mauro, Rordorf Roberto, Abu-Assi Emad, Raposeiras-Roubin Sergio, Biffi Mauro, D'Ascenzo Fabrizio, De Ferrari Gaetano Maria
Аннотация
OBJECTIVES: The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR.
METHODS: PACE-TAVI is an international multicenter registry of all consecutive TAVR patients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF.
RESULTS: A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP ≥40%. After multivariable adjustment, VP ≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P = 0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P = 0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P = 0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80-5.90; P = 0.13). Patients with VP ≥ 40% showed a higher New York Heart Association functional class both at 1 year (P = 0.009) and at last available follow-up (P = 0.04) and a nonsignificant reduction of left ventricular ejection fraction (P = 0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P = 0.009).
CONCLUSIONS: In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization. These findings suggest the opportunity to minimize right VP through dedicated algorithms in post-TAVR patients without complete atrioventricular block and to evaluate a more physiological VP modality in patients with persistent complete atrioventricular block.