Valvular & structural heart diseaseCohort study
Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement (TAVR) With Self-Expanding Valves
- Retrospective analysis of multicentre registries
Authors' conclusion
New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
Study context
- Population
- Patients undergoing transfemoral TAVR with self-expanding valves, NEOPRO and NEOPRO-2 registries, January 2012 to December 2021
- Participants
- 3,211 patients
- Exposure
- New permanent pacemaker implantation (PPI) vs no new PPI after TAVR with self-expanding valves
- Acurate neon = 1,090
- Acurate neo2n = 665
- Evolut PROn = 1,312
- Evolut PRO+n = 144
- Outcome
- Incidence of new permanent pacemaker implantation (PPI)
- Follow-up
- Within 30 days after TAVR
Main finding
As reported in the abstract
New PPI
- New PPI, overall
- 362 patients (11.3%)
Observational data: associations, not effects.
Further findings
| Outcome | New PPI | No new PPI | adjusted HR (95% CI) | P value | |
|---|---|---|---|---|---|
| 1-year mortality, new PPI vs no new PPI | 16.9% | 10.8% | 1.66 (1.13–2.43) | P = 0.010 | |
| 0.512Adjusted hazard ratio (log scale) |
- 1-year mortality, new PPI vs no new PPI: particularly with baseline ejection fraction (EF) <40% (P for interaction = 0.049)
Independent predictors of new PPI
- STS Predicted Risk of Mortality score, baseline right bundle branch block and depth of transcatheter heart valves (THV) implantation, in both Acurate neo/neo2 and Evolut PRO/PRO+
Predischarge reduction in EF
- More frequent in patients requiring PPI
- P = 0.014
Original publication
Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv. Published 19 July 2023. doi:10.1016/j.jcin.2023.05.020
Summarised from the published abstract; every number is checked against it