Effect of permanent pacemaker on mortality after transcatheter aortic valve replacement.
OBJECTIVE
Transcatheter aortic valve implantation (TAVI) is an established treatment for high-grade aortic valve stenosis in patients found unfit for open heart surgery. The method may cause cardiac conduction disorders requiring permanent pacemaker (PPM) implantation, and the long-term effect of PPM implantation remains ambiguous. Design One hundred sixty-eight patients who underwent TAVI from 2008 to 2012 were included. Patient characteristics, ECGs and PPM data were collected through medical records. Kaplan-Meier plots and Cox regression analysis were performed.


RESULTS
Forty subjects were excluded, leaving 128 patients for final inclusion. 41 (32%) received a PPM (mean age 82 vs. 80 in patients without PPM, p = .06) within 30 days of the TAVI procedure. Median follow-up was ∼4 years and 37 (29%) died. One-year mortality was 14% for non-PPM patients vs. 2% in PPM patients, and mortality at 5yrs 70% vs. 54%, respectively. Kaplan-Meier survival analysis showed higher mortality in patients without PPM (p = .008). In multivariate survival analysis significant variables were: No PPM (HR 2.6; CI 1.1-6.2; p = .03), chronic obstructive pulmonary disease (HR 2.4; CI 1.2-5.0; p = .02) and either pre- or post-procedural chronic or paroxystic atrial fibrillation (HR 2.3; CI 1.2-4.7; p= .02).


CONCLUSIONS
TAVI-patients with a PPM had better survival than patients in whom a PPM was not implanted.
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Jonathan
J
Engborg
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Casper
C
Riechel-Sarup
b Department of Nuclear Medicine , Odense University Hospital , Odense C , Denmark.
Oke
O
Gerke
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Hans
H
Mickley
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Niels Christian
NC
Sandgaard
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Henrik
H
Nissen
a Department of Cardiology , Odense University Hospital , Odense C , Denmark.
Axel Cosmus Pyndt
AC
Diederichsen
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D003718:Denmark; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
TAVI; mortality; pacemaker