Abstract 19882: Incidence, Clinical Outcomes and Factors Influencing Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement - A Meta-Analysis of 93 Studies including 37,836 Patients
Background: The impact of transcatheter aortic valve replacement (TAVR) strategy, valve type (balloon-expandable Edwards (ES) valve or self-expanding Medtronic CoreValve (MCV)) and geographical differences (USA or Europe) on new permanent pacemaker (PPM) implantation is unclear. Similarly, the impact of PPM implantation on mortality after TAVR is unclear. We perform the first meta-analysis of incidence, clinical outcomes and factors influencing PPM implantation after TAVR.
Methods and Results: A total of 93 non-overlapping studies including 37,836 patients reporting 30-day PPM implantation rates post-TAVR were included. Random-effects model was used to calculate pooled estimates and risk ratios, summarized in Table 1. MCV (n=8076) was associated with increased PPM implantation rates compared to ES valve (n=20,280) (22.5%, 95% CI 19.4-25.9% vs. 6.5%, 95% CI 5.7-7.4%, p < 0.01). Among patients undergoing ES valve implantation, transapical (TA) approach was associated with increased PPM implantation rates compared to transfemoral (TF) approach (9.1%, 95% CI 6.5-11.5% vs. 4.8%, 95% CI 2.9-7.4%; p=0.02). Among patients undergoing TAVR by TF approach, MCV implantation was associated with increased PPM rates, compared to ES valve (22.51%, 95% CI 18.7-25.9% vs. 4.8%, 95% CI 2.9-7.4%; p<0.01). PPM implantation rates associated with ES or MCV were not statistically different between US or European studies. Compared to patients not requiring PPM post-TAVR, the need for new PPM implantation was not associated with increased 30-day mortality (Risk-ratio 0.84 95% CI 0.61-1.15, p=0.27) or 1-year mortality (Risk-ratio 0.94 95% CI 0.74-1.19, p=0.60).
Conclusions: PPM implantation is a frequent complication after TAVR. This is more commonly associated with MCV and TA approach for ES valve and is not influenced by geographical zones. Despite the high incidence of PPM implantation associated with TAVR, the need for new PPM does not influence 30-day or 1-year mortality.
Author Disclosures: T. Chakravarty: None. R. Cheng: None. Y. Abramowitz: None. A. Noheria: None. H. Jilaihawi: Other; Modest; Consulting fee from Edwards Life Sciences, St. Jude Medical, Venus Medtech. N. Doctor: None. W. Cheng: None. R.R. Makkar: Research Grant; Modest; Edwards Life Sciences, St. Jude Medical, Medtronic. Other; Modest; Consulting fee and lecture fee from Medtronic.
- © 2014 by American Heart Association, Inc.