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Chronic pacing and adverse outcomes after transcatheter aortic valve implantation
  1. Jose’ M Dizon1,2,
  2. Tamim M Nazif1,2,
  3. Paul L Hess3,
  4. Angelo Biviano1,2,
  5. Hasan Garan1,
  6. Pamela S Douglas3,
  7. Samir Kapadia4,
  8. Vasilis Babaliaros5,
  9. Howard C Herrmann6,
  10. Wilson Y Szeto6,
  11. Hasan Jilaihawi7,
  12. William F Fearon8,
  13. E Murat Tuzcu4,
  14. Augusto D Pichard9,
  15. Raj Makkar7,
  16. Mathew Williams10,
  17. Rebecca T Hahn1,2,
  18. Ke Xu2,
  19. Craig R Smith1,2,
  20. Martin B Leon1,2,
  21. Susheel K Kodali1,2
  22. for the PARTNER Publications Office
  1. 1Department of Medicine, Columbia University, New York, New York, USA
  2. 2Cardiovascular Research Foundation, New York, New York, USA
  3. 3Department of Medicine, Duke University, Durham, North Carolina, USA
  4. 4Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Emory University School of Medicine, Atlanta, Georgia, USA
  6. 6Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7Cedars-Sinai Medical Center, Los Angeles, California, USA
  8. 8Stanford University, Stanford, California, USA
  9. 9Medstar Washington Hospital Center, Washington DC, USA
  10. 10NYU Langone Medical Center, New York, New York, USA
  1. Correspondence to Dr Jose’ M Dizon, Department of Medicine, Columbia University, 222 Westchester Ave, White Plains, New York, NY 10604, USA; Jmd11{at}columbia.edu

Abstract

Objective Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.

Methods and results Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01). Prior PPM had worsened recovery of LVEF after TAVI (Δ=10.0 prior vs 19.7% no PPM for baseline LVEF <35%, p<0.0001; Δ=4.1 prior vs 7.4% no PPM for baseline LVEF 35–50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (>88%).

Conclusions In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings.

Trial registration number (ClinicalTrials.gov NCT00530894).

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