Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation: Impact on Late Clinical Outcomes and Left Ventricular Function
Background—Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI). The objective of this study was to assess the impact of PPI following TAVI on late outcomes in a large cohort of patients.
Methods and Results—A total of 1,556 consecutive patients without prior PPI undergoing TAVI were included. 239 patients (15.4%) required a PPI within the first 30 days following TAVI. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (HR: 0.98, 95% CI:0.74-1.30, P=0.871), cardiovascular mortality (HR: 0.81, 95% CI: 0.56-1.17, P=0.270), and all-cause mortality or rehospitalization due to heart failure (HR: 1.00, 95% CI:0.77-1.30, P=0.980). A lower rate of sudden or unknown death was observed in patients with PPI (HR: 0.31, 95% CI: 0.11-0.85, P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction (LVEF) over time (P=0.017), and new PPI was an independent predictor of LVEF decrease at 6- to 12-month follow-up (estimated coefficient: -2.26, 95% CI:-4.07 to -0.44, P= 0.013, R2: 0.121).
Conclusions—The need for PPI was a frequent complication of TAVI, but it was not associated with any increase in overall or cardiovascular death or rehospitalization due to heart failure after a mean follow-up of ~ 2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
- transcatheter aortic valve implantation
- aortic stenosis
- percutaneous aortic valve replacement
- sudden cardiac death
- Received August 7, 2013.
- Revision received December 16, 2013.
- Accepted December 17, 2013.