Chronic pacing and adverse outcomes after transcatheter aortic valve implantation. Issue 20 (10th August 2015)

• Record Type: Journal Article
• Authors: Dizon, Jose' M; Nazif, Tamim M; Hess, Paul L; Biviano, Angelo; Garan, Hasan; Douglas, Pamela S; Kapadia, Samir; Babaliaros, Vasilis; Herrmann, Howard C; Szeto, Wilson Y; Jilaihawi, Hasan; Fearon, William F; Tuzcu, E Murat; Pichard, Augusto D; Makkar, Raj; Williams, Mathew; Hahn, Rebecca T; Xu, Ke; Smith, Craig R; Leon, Martin B; Kodali, Susheel K
• Is Part Of: Heart. Volume 101:Issue 20(2015)
• Page Start: 1665
• Page End: 1671
• Publication Date: 2015-08-10
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2015-307666
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes. Methods and results: Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01). Prior PPM had worsened recovery of LVEF after TAVI (Δ=10.0 prior vs 19.7% no PPM for baseline LVEF <35%, p<0.0001; Δ=4.1 prior vs 7.4% no PPM for baseline LVEF 35–50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (>88%). Conclusions: In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings. Trial registration number: (ClinicalTrials.gov NCT00530894 ).