# Impact of Rapid Pacing Time on Myocardial Injury in Transcatheter Aortic Valve Implantation for Non–End-stage Renal Disease Patients

## TL;DR

This study finds that longer rapid pacing times during heart valve implantation are linked to higher heart injury markers, which may affect short-term outcomes.

## Contribution

The study identifies rapid pacing duration as a novel predictor of myocardial injury in TAVI patients without severe kidney disease.

## Key findings

- Longer rapid pacing times were associated with higher troponin levels and increased PMI rates.
- ΔcTnT independently predicted 30-day major adverse cardiovascular events.
- Renal function inversely correlated with troponin levels, indicating a role beyond pacing time.

## Abstract

Periprocedural myocardial injury (PMI) is a concern in transcatheter aortic valve implantation (TAVI), with rapid pacing (RP) suspected to be a contributing factor. PMI is defined by elevated troponin levels. In this study we determined the net effect of RP on PMI after excluding patients with severe renal dysfunction by evaluating troponin elevation after TAVI.

We included 137 patients who underwent TAVI between September 2023 and January 2025. The association between renal function and cardiac troponin T (cTnT) level was investigated. Patients were categorized according to the RP time (RPT) to investigate its association with cTnT elevation, PMI, and short-term outcomes. The 100 patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min per 1.73 m2 were divided into 2 groups: short (< 18 seconds, n = 49) and long (≥ 18 seconds, n = 51) RPT. The primary endpoint was PMI/troponin levels, whereas the secondary endpoints were 30-day all-cause death and major adverse cardiovascular events (MACE).

The eGFR inversely correlated with cTnT levels (P < 0.001). The long RPT group had significantly higher cTnT values (P = 0.026) and PMI rates (14.2% vs 33.3%, P = 0.034) vs the short RPT group. The 30-day prognosis did not differ between the short and long RPT groups. Patients with PMI exhibited a trend toward higher MACE (P = 0.051) vs those without PMI. ΔcTnT independently predicted 30-day MACE (P = 0.043).

A longer RPT significantly increased troponin levels, indicating PMI, which was associated with worse short-term prognosis of cardiovascular events. However, other factors, such as renal dysfunction, rather than only longer RPT, are also associated with increased troponin level.