Abstract 13753: The Impact of Previous Permanent Pacemaker on Outcomes After Transcatheter Aortic Valve Replacement
Background: Although pacemaker implantation during TAVR has not been associated with unfavorable short-term outcomes, patients with previous long-term ventricular pacing may develop singular left ventricular dyssynchrony and adverse ventricular remodeling. Additional information on clinical profile, biventricular function and outcome influence of previous pacemaker following TAVR is relevant to the patient care. The objective of this analysis was to compare the clinical profile, biventricular function and the outcome differences of patients with and without previous permanent pacemaker implantation referred to transcatheter aortic valve replacement (TAVR).
Methods: TAVR patients were stratified according to the presence (PrePPM) or not (NoPPM) of prior pacemaker. We compared the clinical profile and the adjusted 1-year all-cause mortality. The biventricular function was assessed by echocardiogram comparing pre- and post-TAVR atrio-biventricular function and structure.
Results: The study population comprised 254 consecutive patients (age: 84 ± 8 years) who underwent TAVR for symptomatic aortic stenosis. The PrePPM group was characterized by a higher risk profile: prior coronary bypass surgery (16% vs. 49%; p <.01), prior myocardial infarction (47% vs. 29%; p <.03) and left ventricular ejection fraction <40% (44% vs. 20%; p <.04) compared to NoPPM. Also, the PrePPM group had more moderate-severe right ventricular dysfunction (35% vs. 14%; p <.05), moderate tricuspid regurgitation (17% vs. 8%; p=.08) and lower mean aortic valve gradient (42 mm Hg ± 12 vs. 50 ± 13 vs. p <.01). Despite similar left ventricular outflow track diameters (2.0 cm ± 0.2 vs. 2.0 ± 0.1; p=.2) the PrePPM patients had a higher frequency of small prosthesis (23-mm) (55% vs. 37%; p <.03). After the procedure, the PrePPM group had higher immediate left ventricular systolic dimension regression ([[Unable to Display Character: ▵]]:0.3cm ± 0.5 vs. 0 ± 0.6; p<.01). The adjusted-hazard risk of 1-year mortality was similar (HR=0.9 CI 95% [0.3-2.5]).
Conclusions: Although the clinical profile, biventricular structure/function and the immediate response are different, in PrePPM patients referred to TAVR the presence of a PPM prior to TAVR did not translate into higher 1-year mortality.
- © 2013 by American Heart Association, Inc.