Pacemaker implantation after ViV-TAVR ups mortality at follow-up

The rate of periprocedural permanent pacemaker implantation (PPI) in a contemporary large series of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) patients is relatively low, with its incidence decreasing with the use of new-generation transcatheter heart valves (THVs), reveals a study. Notably, PPI following ViV-TAVR leads to a trend toward higher deaths at follow-up.

In this study, the authors obtained data from the multicentre VIVID Registry and included the main baseline and procedural characteristics. In-hospital and late (median follow-up, 13 months; interquartile range, 3–42 months) outcomes were analysed according to the need of periprocedural PPI. All THVs were considered new-generation, except for CoreValve, Cribier-Edwards, Sapien, and Sapien XT.

Of the 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 included, 128 (6.4 percent) had PPI after TAVR. There was significant decrease in the incidence of PPI with the use of new-generation THVs (4.7 percent vs 7.4 percent; p=0.017), primarily related to a reduced PPI rate with the Evolut R/Pro vs CoreValve (3.7 percent vs 9.0 percent; p=0.002).

No significant differences in PPI rates were noted between newer-generation balloon- and self-expanding THVs (6.1 percent vs 3.9 percent; p=0.18).

Multivariable analysis revealed the following factors associated with an increased PPI risk: older age (odds ratio [OR] for each increase of 1 year, 1.05, 95 percent confidence interval [CI], 1.02–1.07; p=0.001), larger THV size (OR, 1.10, 95 percent CI, 1.01–1.20; p=0.02), and previous right bundle branch block (OR, 2.04, 95 percent CI, 1.00–4.17; p=0.05).

No significant differences were observed in 30-day mortality between the PPI and no PPI groups (4.7 percent vs 2.7 percent; p=0.19). However, PPI patients appeared to have a higher mortality risk at follow-up (hazard ratio, 1.39, 95 percent CI, 1.02–1.91; p=0.04; p=0.08 after adjusting for age differences between groups).