TY - JOUR T1 - Chronic pacing and adverse outcomes after transcatheter aortic valve implantation JF - Heart JO - Heart SP - 1665 LP - 1671 DO - 10.1136/heartjnl-2015-307666 VL - 101 IS - 20 AU - Jose’ M Dizon AU - Tamim M Nazif AU - Paul L Hess AU - Angelo Biviano AU - Hasan Garan AU - Pamela S Douglas AU - Samir Kapadia AU - Vasilis Babaliaros AU - Howard C Herrmann AU - Wilson Y Szeto AU - Hasan Jilaihawi AU - William F Fearon AU - E Murat Tuzcu AU - Augusto D Pichard AU - Raj Makkar AU - Mathew Williams AU - Rebecca T Hahn AU - Ke Xu AU - Craig R Smith AU - Martin B Leon AU - Susheel K Kodali Y1 - 2015/10/15 UR - http://heart.bmj.com/content/101/20/1665.abstract N2 - 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). ER -