The interplay between permanent pacemaker implantation and mortality in patients treated by transcatheter aortic valve implantation: A systematic review and meta‐analysis

• Published in: Catheterization and cardiovascular interventions Vol. 92; no. 3; pp. E159 - E167
• Main Authors: Ueshima, Daisuke, Nai Fovino, Luca, Mojoli, Marco, Napodano, Massimo, Fraccaro, Chiara, Tarantini, Giuseppe
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2018
• Subjects: Aged; Aged, 80 and over; Aortic valve; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Cardiac Pacing, Artificial - adverse effects; Cardiac Pacing, Artificial - mortality; Conduction; Female; Heart Valve Prosthesis; Humans; Male; Meta-analysis; Mortality; Pacemaker, Artificial; permanent pacemaker; Population studies; Postoperative Complications - mortality; Risk Assessment; Risk Factors; Systematic review; Time Factors; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; transcatheter aortic valve implantation; mortality; permanent pacemaker
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.27681

Background Previous implantation of a permanent pacemaker (PPM) is common among patients undergoing transcatheter aortic valve implantation (TAVI). Moreover, onset of conduction disturbances needing new PPM implantation after TAVI is frequent. The interplay of pre‐existing and new‐PPM on mortality after TAVI remains controversial. Methods We performed a systematic review and study‐level meta‐analysis on the influence of PPM on mortality after TAVI. Patients were divided into 3 groups: pre‐existing PPM, new‐PPM (implantation within 30 days after TAVI) and no‐PPM (without PPM up to 30 days after TAVI). Outcomes were compared using pairwise and network meta‐analysis. Results A total of 28 studies including 40,016 subjects were eligible. Patients of the no‐PPM group had a lower mortality outcome compared to the rest of the study population (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68‐0.85, P < 0.0001) at median follow up of 16.3 months. In particular, patients with a pre‐existing PPM (RR 1.43, 95% CI 1.26‐1.62, P < 0.0001), but not those with a newly implanted PPM (RR 1.08, 95% CI 0.99‐1.18, P = 0.10), had a significantly higher mortality compared to patients of the no‐PPM group. Moreover, meta‐regression analysis showed that the transapical approach rate had a detrimental interaction with pre‐existing PPM on mortality (P = 0.03). Conclusion Compared to patients without PPM, those with a pre‐existing PPM before TAVI had higher mortality, in particular if treated by the transapical approach. New‐PPM implantation did not have a negative relation on mid‐term outcome.