Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation

Bruno, F; Munoz Pousa, I; Saia, F; Vaira, MP; Baldi, E; Leone, PP; Cabanas-Grandio, P; Corcione, N; Spinoni, EG; Annibali, G; Russo, C; Ziacchi, M; Caruzzo, CA; Ferlini, M; Lanzillo, G; De Filippo, O; Dusi, V; Gallone, G; Castagno, D; Patti, G; La Torre, M; Musumeci, G; Giordano, A; Stefanini, G; Salizzoni, S; Conrotto, F; Rinaldi, M; Rordorf, R; Abu-Assi, E; Raposeiras-Roubin, S; Biffi, M; D'Ascenzo, F; De Ferrari, GM

doi:10.1016/j.jcin.2023.02.003

Arrhythmias & electrophysiology

Impact of Right Ventricular Pacing in Patients With Transcatheter Aortic Valve Replacement (TAVR) Undergoing Permanent Pacemaker Implantation

JACC Cardiovasc IntervPublished 8 May 2023Registry study

Main finding · CV mortality or HF hospitalizationResultHazard ratio 2.76 95% CI 1.39–5.51

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Authors' conclusion

In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization.

Study context

Population: Consecutive TAVR patients with permanent pacemaker implantation for conduction disturbances within 30 days after the procedure
Participants: 377 patients

Exposure: Ventricular pacing (VP) ≥40% vs VP <40%
VP ≥40%n = 219
VP <40%n = 158reference
Outcome: CV mortality or hospitalization for heart failure (HF)

Methodological detailsinternational multicentre, multivariable adjustment

International multicentre
Multivariable adjustment

Main finding

CV mortality or HF hospitalization

Hazard ratio

2.76

95% CI 1.39–5.51

P = 0.004

VP ≥40%vs VP <40%

HR 2.76 (95% CI 1.39–5.51); P = 0.004

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with VP ≥40% ←→ Higher risk with VP ≥40% →	HR (95% CI)	P value
First HF hospitalization	0.050.21520	3.37 (1.50–7.54)	P = 0.003
CV death	0.050.21520	3.77 (1.02–13.88)	P = 0.04
All-cause death	0.050.21520	2.17 (0.80–5.90)	P = 0.13
	0.050.21520Hazard ratio (log scale)

NYHA functional class · 1 year and last available follow-up

Higher NYHA class with VP ≥40% at 1 year: P = 0.009
Higher NYHA class with VP ≥40% at last available follow-up: P = 0.04

LVEF on echocardiography · 1 year

Nonsignificant LVEF reduction with VP ≥40%: P = 0.18
Significant LVEF improvement with VP <40%: P = 0.009

Reference

Authors: Bruno F, Munoz Pousa I, Saia F, Vaira MP, Baldi E, Leone PP, et al.
All 33 authors
Bruno F, Munoz Pousa I, Saia F, Vaira MP, Baldi E, Leone PP, Cabanas-Grandio P, Corcione N, Spinoni EG, Annibali G, Russo C, Ziacchi M, Caruzzo CA, Ferlini M, Lanzillo G, De Filippo O, Dusi V, Gallone G, Castagno D, Patti G, La Torre M, Musumeci G, Giordano A, Stefanini G, Salizzoni S, Conrotto F, Rinaldi M, Rordorf R, Abu-Assi E, Raposeiras-Roubin S, Biffi M, D'Ascenzo F, De Ferrari GM
Journal: JACC: Cardiovascular Interventions
Published: 8 May 2023
DOI: 10.1016/j.jcin.2023.02.003
PubMed: 37164607

Topic: Arrhythmias & electrophysiology
Also indexed: Valvular & structural heart disease

Exposure definitions

VP <40%: percentage of VP <40% at pacemaker interrogation
VP ≥40%: percentage of VP ≥40% at pacemaker interrogation

Key notes

Multivariable adjusted

Original publication

Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation. JACC Cardiovasc Interv. Published 8 May 2023. doi:10.1016/j.jcin.2023.02.003

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