Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial.
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Tobe Akihiro, Smits Pieter C, van Royen Niels, Amat-Santos Ignacio J, Hudec Martin, Bunc Matjaz, Van den Branden Ben J L, Laanmets Peep, Unic Daniel, Merkely Bela, Hermanides Renicus S, Ninios Vlasis, Protasiewicz Marcin, Rensing Benno J W M, Martin Pedro L, Feres Fausto, Almeida Manuel De Sousa, van Belle Eric, Linke Axel, Ielasi Alfonso, Montorfano Matteo, Webster Mark, Toutouzas Konstantinos, Teiger Emmanuel, Bedogni Francesco, Voskuil Michiel, Pan Manuel, Angerås Oskar, Kim Won-Keun, Rothe Jürgen, Kristić Ivica, Peral Vicente, Garg Scot, Versteeg Geert A A, García-Gómez Mario, Tsai Tsung-Ying, Thakkar Ashokkumar, Chandra Udita, Morice Marie-Claude, Onuma Yoshinobu, Baumbach Andreas, Serruys Patrick W
Аннотация
METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up.
RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02.
CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.