Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry.
The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR).



Conduction abnormalities leading to PPM implantation are common complications following TAVR. Whether PPM placement can be predicted or is associated with adverse outcomes is unclear.



A retrospective cohort study of patients undergoing TAVR in the United States at 229 sites between November 2011 and September 2014 was performed using the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and the Centers for Medicare and Medicaid Services database.



PPM placement was required within 30 days of TAVR in 651 of 9,785 patients (6.7%) and varied among those receiving self-expanding valves (25.1%) versus balloon-expanding valves (4.3%). Positive predictors of PPM implantation were age (per 5-year increment, odds ratio: 1.07; 95% confidence interval [CI]: 1.01 to 1.15), prior conduction defect (odds ratio: 1.93; 95% CI: 1.63 to 2.29), and use of self-expanding valve (odds ratio: 7.56; 95% CI: 5.98 to 9.56). PPM implantation was associated with longer median hospital stay (7 days vs. 6 days; p < 0.001) and intensive care unit stay (56.7 h vs. 45.0 h; p < 0.001). PPM implantation was also associated with increased mortality (24.1% vs. 19.6%; hazard ratio [HR]: 1.31; 95% CI: 1.09 to 1.58) and a composite of mortality or heart failure admission (37.3% vs. 28.5%; hazard ratio HR: 1.33; 95% CI: 1.13 to 1.56) at 1 year but not with heart failure admission alone (16.5% vs. 12.9%; HR: 1.23; 95% CI: 0.92 to 1.63).



Early PPM implantation is a common complication following TAVR, and it is associated with higher mortality and a composite of mortality or heart failure admission at 1 year.
Department of Medicine, Reading Health System, West Reading, Pennsylvania. Electronic address: yemi.fadahunsi@nshealth.ca.
Opeyemi O
OO
Fadahunsi
Children's Hospital Los Angeles, Los Angeles, California.
Abiola
A
Olowoyeye
Department of Medicine, Reading Health System, West Reading, Pennsylvania; Division of Cardiology, Hershey Medical Center, Hershey, Pennsylvania.
Anene
A
Ukaigwe
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Zhuokai
Z
Li
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Amit N
AN
Vora
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Sreekanth
S
Vemulapalli
Division of Cardiology, Cardiology Associates of West Reading, West Reading, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania.
Eric
E
Elgin
Department of Medicine, Reading Health System, West Reading, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania.
Anthony
A
Donato
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D014487:Centers for Medicare and Medicaid Services, U.S.; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
aortic stenosis; heart failure; mortality; pacemaker; registry; transcatheter aortic valve replacement