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Pacemaker Dependency after Transcatheter Aortic Valve Implantation: Incidence, Predictors and Long-term outcomes.

AIMS
To determine the appropriateness of permanent pacemaker implantation (PPI) after TAVI through an analysis of PM dependency at follow-up, and to assess long-term outcomes of patients undergoing PPI after TAVI.


METHODS AND RESULTS
From June 2007 to February 2018, 1116 consecutive patients without prior PM underwent TAVI in our Institution. We assessed incidence and predictors of PM dependency of patients who underwent PPI within 30 days, and 6-year outcomes among patients who underwent and did not undergo PPI at 30 days. At 30-day PPI was reported in 145 patients (13.0%). Rates of PM dependency were 35.7%, 35.8% and 33.3% at 1-, 6- and 12-month, respectively. Analyzing PPI timing, implantation on day 1 was found a predictor of PM dependency at 6 (OR 20.7[CI 3.4-126.7]; p=0.001) and 12 months (OR 7.5[CI 1.4-40.2]; p=0.019). An interaction between PM dependency and the presence of baseline right bundle branch block (RBBB) at 6 (pinteraction=0.024) and 12 months (pinteraction=0.028) was reported when PPI was performed on the same day of TAVI. At 6-year, patients who received a PM at 30 days showed a higher all-cause death rate (KM estimate 41.7% vs. 57%; plog-rank=0.034).


CONCLUSIONS
Among patients receiving PPI after TAVI, PM dependency rates were about 33-36% at 1-year. Patients with a baseline RBBB undergoing PPI at day 0 or at day 1 when severe CDs persisted for 24 hours after TAVI, irrespectively from baseline CDs, had higher chances to be PM dependent at follow-ups. Finally, PPI after TAVI was associated with increased 6-year mortality.