Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self-Expanding Prosthesis.

BACKGROUND

With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR.

AIMS: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis.

METHODS

Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up.

RESULTS

Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001).

CONCLUSIONS

PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.