Permanent Pacemaker Implantation After TAVI and Its Association with Survival: Single-Center Cohort and Nationwide Validation

TL;DR

This study finds that getting a new pacemaker after a heart valve procedure does not increase long-term risk of death, but having a pacemaker before the procedure does.

Contribution

The study provides real-world evidence that post-TAVI pacemaker implantation is not linked to higher mortality, unlike pre-existing pacemakers.

Findings

Post-TAVI pacemaker implantation was not associated with 1- or 5-year mortality.

Pre-existing pacemaker status was independently linked to higher 5-year mortality.

Findings were validated in a nationwide database.

Abstract

Background/Objectives: Permanent pacemaker (PM) implantation is a well-recognized complication of transcatheter aortic valve implantation (TAVI), but its long-term prognostic impact remains uncertain. To evaluate the association between PM implantation and all-cause mortality in TAVI recipients. Methods: We performed a post hoc analysis of a prospective single-center TAVI registry (2016–2020). The primary endpoint was all-cause mortality at 1 and 5 years. Cox regression and Kaplan–Meier analyses were applied. Validation was performed using the nationwide AUTHEARTVISIT claims database. Results: Among 1114 consecutive TAVI patients (mean age 81  ±  5.8 years; 49.8% female), 120 (10.8%) had a pre-existing PM (Pre-PM), and 153 (13.7%) received a new PM within 30 days post-TAVI (Post-PM). Post-PM patients were older (p = 0.006), more often male (p < 0.001), had higher Troponin T levels (p = 0.002), more pre-existing right bundle branch block (p < 0.001), and longer QRS duration (p < 0.001) compared to patients without PM. In multivariate analysis, one-year mortality was associated with Troponin T (p = 0.002) and NT-proBNP (p = 0.002) serum levels. Pre- or Post-PM status was not associated with 1-year mortality (p = 0.455, p = 975). However, Pre-PM status was independently associated with 5-year mortality (HR 1.4, 95% CI: 1.0–1.9, p = 0.03), whereas Post-PM status was not (HR 1.2, 95% CI: 0.8–1.6, p = 0.22). Findings were confirmed in the nationwide AUTHEARTVISIT cohort. Conclusions: In this large, real-world TAVI cohort with national validation, Post-PM status was not associated with mortality at 1 or 5 years. By contrast, Pre-PM identified patients at higher long-term risk, possibly reflecting underlying cardiac disease.

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