Incidence, predictors and clinical impact of permanent pacemaker insertion in women following transcatheter aortic valve implantation: Insights from a prospective multinational registry. Issue 6 (12th June 2021)

• Record Type: Journal Article
• Authors: Nicolas, Johny; Guedeney, Paul; Claessen, Bimmer E.; Mehilli, Julinda; Petronio, Anna Sonia; Sartori, Samantha; Lefèvre, Thierry; Presbitero, Patrizia; Capranzano, Piera; Iadanza, Alessandro; Cao, Davide; Chiarito, Mauro; Goel, Ridhima; Roumeliotis, Anastasios; Chandiramani, Rishi; Chen, Siyan; Sardella, Gennaro; Van Mieghem, Nicolas M.; Sorrentino, Sabato; Meliga, Emanuele; Tchétché, Didier; Dumonteil, Nicolas; Fraccaro, Chiara; Trabattoni, Daniela; Mikhail, Ghada W.; Ferrer‐Gracia, Maria‐Cruz; Naber, Christoph; Kievit, Peter C.; Baber, Usman; Sharma, Samin K.; Morice, Marie‐Claude; Dangas, George D.; Chandrasekhar, Jaya; Chieffo, Alaide; Mehran, Roxana;
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 6(2021)
• Page Start: E908
• Page End: E917
• Publication Date: 2021-06-12
• Subjects: gender -- pacemaker -- TAVI -- TAVR; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29807
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To describe the incidence, predictors, and clinical impact of permanent pacemaker insertion (PPI) following transcatheter aortic valve replacement (TAVR) in women. Background: Data on pacemaker insertion complicating TAVR in women are scarce. Methods: The Women's International Transcatheter Aortic Valve implantation (WIN‐TAVI) is a prospective registry evaluating the safety and efficacy of TAVR in women. We included patients without preprocedural pacemakers and divided them into two groups: (1) PPI and (2) no‐PPI. We identified PPI predictors using logistic regression and studied its clinical impact on the Valve Academic Research Consortium (VARC)‐2 efficacy and safety endpoints. Results: Out of 1019 patients, 922 were included in the analysis. Post‐TAVR PPI occurred in 132 (14.3%) patients. Clinical and procedural characteristics were similar in both groups. Pre‐existing right bundle branch block (RBBB) was associated with a high risk of post‐TAVR PPI (OR 3.62, 95% CI 1.85–7.06, p < 0.001), while implantation of balloon‐expandable prosthesis was associated with a lower risk (OR 0.47, 95% CI 0.30–0.74, p < 0.001). Post‐TAVR PPI prolonged in‐hospital stay by a median of 2 days (11 [9–16] days in PPI vs. 9 [7–14] days in no‐PPI, p = 0.005), yet risks of VARC‐2 efficacy and safety endpoints at 1 year were similar in both groups (adj HR 0.95, 95% CI 0.60–1.52, p = 0.84 and adj HR 1.22, 95% CI 0.83–1.79, p = 0.31, respectively). Conclusion: Pacemaker implantation following TAVR is frequent among women and is associated with pre‐existing RBBB and valve type. PPI prolongs hospital stay, albeit without any significant impact on 1‐year outcomes.