Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

• Published in: JACC. Cardiovascular interventions Vol. 9; no. 21; pp. 2189 - 2199
• Main Authors: Fadahunsi, Opeyemi O., MBBS, MPH, Olowoyeye, Abiola, MD, MPH, Ukaigwe, Anene, MD, Li, Zhuokai, PhD, Vora, Amit N., MD, MPH, Vemulapalli, Sreekanth, MD, Elgin, Eric, MD, Donato, Anthony, MD, MHPE
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 14.11.2016
• Subjects: aortic stenosis; Cardiovascular; heart failure; mortality; pacemaker; registry; transcatheter aortic valve replacement; pacemaker; HR; interquartile range; odds ratio; PPM; TAVR; aortic stenosis; STS; Society of Thoracic Surgeons; heart failure; registry; ACC; OR; CI; ESV; American College of Cardiology; IQR; Medtronic CoreValve Revalving System; Edwards SAPIEN valve; permanent pacemaker; MCRS; mortality; transcatheter aortic valve replacement; hazard ratio; confidence interval
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.07.026

Abstract Objectives The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR). Background Conduction abnormalities leading to PPM implantation are common complications following TAVR. Whether PPM placement can be predicted or is associated with adverse outcomes is unclear. Methods A retrospective cohort study of patients undergoing TAVR in the United States at 229 sites between November 2011 and September 2014 was performed using the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and the Centers for Medicare and Medicaid Services database. Results PPM placement was required within 30 days of TAVR in 651 of 9,785 patients (6.7%) and varied among those receiving self-expanding valves (25.1%) versus balloon-expanding valves (4.3%). Positive predictors of PPM implantation were age (per 5-year increment, odds ratio: 1.07; 95% confidence interval [CI]: 1.01 to 1.15), prior conduction defect (odds ratio: 1.93; 95% CI: 1.63 to 2.29), and use of self-expanding valve (odds ratio: 7.56; 95% CI: 5.98 to 9.56). PPM implantation was associated with longer median hospital stay (7 days vs. 6 days; p < 0.001) and intensive care unit stay (56.7 h vs. 45.0 h; p < 0.001). PPM implantation was also associated with increased mortality (24.1% vs. 19.6%; hazard ratio [HR]: 1.31; 95% CI: 1.09 to 1.58) and a composite of mortality or heart failure admission (37.3% vs. 28.5%; hazard ratio HR: 1.33; 95% CI: 1.13 to 1.56) at 1 year but not with heart failure admission alone (16.5% vs. 12.9%; HR: 1.23; 95% CI: 0.92 to 1.63). Conclusions Early PPM implantation is a common complication following TAVR, and it is associated with higher mortality and a composite of mortality or heart failure admission at 1 year.