Impact of Permanent Pacemaker Implantation on Clinical Outcome Among Patients Undergoing Transcatheter Aortic Valve Implantation

Jun 20, 2012
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Authors:
Buellesfeld L, Stortecky S, Heg D, et al.
Citation:
J Am Coll Cardiol 2012;Jun 20:[Epub ahead of print].
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of permanent pacemaker (PPM) implantation on clinical outcome of patients undergoing transfemoral transcatheter aortic valve implantation (TAVI)?

Methods:

The authors compared the impact of PPM implantation on 353 patients who underwent TAVI between 2007 and 2010 at two institutions. Patients were divided into three groups: (a) those requiring PPM implantation after TAVI (PPM after TAVI), (b) those with no PPM before or after TAVI (no PPM), and (c) patients with PPM before TAVI (PPM before TAVI). The primary endpoint was all-cause mortality at 12 months.

Results:

PPM after TAVI was required in 98 patients (27.8%), whereas 48 patients (13.6%) had a PPM before TAVI, and 207 patients (58.6%) belonged to the no PPM group. PPM was required in 29.2% of patients treated with Medtronic Core Valve and 14.7% of patients with Edwards Sapien valve. The PPM before TAVI patients had a significantly higher baseline risk compared with the PPM after TAVI and no PPM patients. In patients requiring PPM after TAVI, the median time to implantation was 3 days after TAVI. At 12 months of follow-up, there was no difference in all-cause mortality between the three groups (PPM after TAVI group: 19.4%, PPM before TAVI group: 22.9%, no PPM group: 18.0%, p = 0.77) and the results were similar after adjusting for baseline differences (p = 0.90). Compared with an age- and gender-matched population, adjusted hazard ratios for death were 2.37 (95% confidence interval, 1.51-3.72) for the PPM after TAVI group, 2.75 (95% confidence interval, 1.52-4.97) for the PPM before TAVI group, and 2.24 (95% confidence interval, 1.62-3.09) for the no PPM group.

Conclusions:

The authors concluded that PPM implantation is commonly required after TAVI, but does not appear to impact 1-year mortality.

Perspective:

PPM is required in a significant number of patients after TAVI, and the complication is generally considered a relatively minor issue. This study confirms that the need for PPM does not appear to impart an adverse prognosis at least up to 1 year.

Keywords: Heart Valve Prosthesis, Transcription Factors, Guanine, Pacemaker, Artificial, Confidence Intervals, Heart Valve Prosthesis Implantation, Subclavian Vein


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