title: Permanent pacemaker implantation after transcatheter aortic valve implantation: impact on late clinical outcomes and left ventricular function.
abstract: BACKGROUND
  Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients.
  
  
  RESULTS
  A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74-1.30; P=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56-1.17; P=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77-1.30; P=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11-0.85; P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (P=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6- to 12-month follow-up (estimated coefficient, -2.26; 95% confidence interval, -4.07 to -0.44; P=0.013; R(2)=0.121).
  
  
  CONCLUSIONS
  The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (M.U., E.D., R.D., H.B.R., L.N.-F., F.P., J.R.-C.); St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada (J.G.W., M.B.); Ferrarotto Hospital, University of Catania, Catania, Italy (C.T., M.B., S.I.); Hospital Clínico de Málaga, Universidad de Málaga, Málaga, Spain (A.J.M.-G., J.H.A.B.); St. Michael's Hospital, Toronto University, Toronto, ON, Canada (A.C., H.A.L.); Clínica de Occidente de Cali, Cali, Colombia (A.E.D., L.M.B., A.M.C.); Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (V.S., B.G.d.B.); and Hospital Clinico Universitario de Valladolid, Valladolid, Spain (I.A.-S., J.L.).
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Muñoz-García
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.forename: Juan H Alonso
authors.initials: JH
authors.lastname: Briales
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Benitez
authors.forename: Hatim
authors.initials: H
authors.lastname: Al Lawati
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Cucalon
authors.forename: Bruno
authors.initials: B
authors.lastname: García Del Blanco
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Robert
authors.initials: R
authors.lastname: Delarochellière
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000639:trends*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000639:trends*; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: aortic stenosis; aortic valve; death, sudden, cardiac; heart valves; pacemaker, artificial