Early and Late Pacemaker Implantation After TAVR

Nov 09, 2020
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Authors:
Mazzella AJ, Hendrickson MJ, Arora S, et al.
Citation:
Shifting Trends in Timing of Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020;Nov 9:[Epub ahead of print].
Summary By:
Thomas C. Crawford, MD, FACC

Quick Takes

  • Rates of PPM implantation after TAVR ranged between 8-12.5% from 2012-2017 without a change over time.
  • The length of stay for index TAVR hospitalization decreased from 6 days in 2012 to 2 days in 2017, while the proportion of PPM implants during a subsequent hospitalization after discharge from TAVR increased from 7% in 2012 to 13% in 2017.
  • There is an increasing trend of high-degree AV block diagnosis requiring PPM implantation presenting after discharge from index TAVR hospitalization.

Study Questions:

What is the rate of permanent pacemaker (PPM) implantation before discharge and after discharge following transcatheter aortic valve replacement (TAVR)?

Methods:

The authors used the Healthcare Cost and Utilization Project Nationwide Readmissions Database to examine trends in PPM implantation during index TAVR hospitalization and during a subsequent hospitalization within 30 days after discharge from TAVR.

Results:

Among 62,083 patients, 6,817 (11%) underwent PPM implantation after TAVR with 9.9% occurring during the same hospitalization, and 1.1% occurring during a subsequent hospitalization. Rates of PPM implantation after TAVR ranged between 8-12.5% from 2012-2017 without a change over time. However, as overall length of stay for index TAVR hospitalization decreased from 2012-2017 (median of 6 days in 2012 to 2 days in 2017), there was an increase in the proportion of PPM implants during a subsequent hospitalization after discharge from TAVR (from 7% in 2012 to 13% in 2017). Of the PPMs implanted after discharge from TAVR, 80% of PPMs were implanted within 14 days after valve replacement.

Conclusions:

The authors concluded that there is an increasing trend of high-degree atrioventricular (AV) block diagnosis requiring PPM implantation presenting after discharge from index TAVR hospitalization, and it is likely driven by the reduced length of stay post-TAVR.

Perspective:

As confidence in TAVR procedures increases, patients are being discharged sooner and sooner after TAVR. Shortened hospitalization results in potentially increased risk for high-degree AV block, which can present with syncope or sudden cardiac arrest. Unfortunately, our ability to predict heart block within a few days is currently limited, and as the author suggests, may be countervailed by using real-time mobile cardiac telemetric monitoring during the first 2 weeks postop.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Arrhythmias, Cardiac, Atrioventricular Block, Death, Sudden, Cardiac, Heart Failure, Heart Valve Diseases, Length of Stay, Pacemaker, Artificial, Patient Discharge, Patient Readmission, Syncope, Transcatheter Aortic Valve Replacement, AHA20, AHA Annual Scientific Sessions


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