Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Chekrallah Chamandi; Marco Barbanti; Antonio Munoz-Garcia; Azeem Latib; Luis Nombela-Franco; Enrique Gutiérrez-Ibanez; Gabriela Veiga-Fernandez; Asim N. Cheema; Ignacio Cruz-Gonzalez; Vicenç Serra; Corrado Tamburino; Antonio Mangieri; Antonio Colombo; Pilar Jiménez-Quevedo; Jaime Elizaga; Gerard Laughlin; Dae-Hyun Lee; Bruno Garcia del Blanco; Tania Rodriguez-Gabella; Josep-Ramon Marsal; Mélanie Côté; François Philippon; Josep Rodés-Cabau

doi:10.1016/j.jcin.2017.10.032

JACC: Cardiovascular Interventions

Volume 11, Issue 3, February 2018 DOI: 10.1016/j.jcin.2017.10.032

Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Chekrallah Chamandi, Marco Barbanti, Antonio Munoz-Garcia, Azeem Latib, Luis Nombela-Franco, Enrique Gutiérrez-Ibanez, Gabriela Veiga-Fernandez, Asim N. Cheema, Ignacio Cruz-Gonzalez, Vicenç Serra, Corrado Tamburino, Antonio Mangieri, Antonio Colombo, Pilar Jiménez-Quevedo, Jaime Elizaga, Gerard Laughlin, Dae-Hyun Lee, Bruno Garcia del Blanco, Tania Rodriguez-Gabella, Josep-Ramon Marsal, Mélanie Côté, François Philippon and Josep Rodés-Cabau

Author + information

vol. 11 no. 3 301-310

DOI:

https://doi.org/10.1016/j.jcin.2017.10.032

Published By:

JACC: Cardiovascular Interventions

Print ISSN:

1936-8798

Online ISSN:

1876-7605

History:

Received July 20, 2017
Revision received October 18, 2017
Accepted October 24, 2017
Published online February 5, 2018.

2018 American College of Cardiology Foundation

Author Information

Chekrallah Chamandi, MD^a,
Marco Barbanti, MD^b,
Antonio Munoz-Garcia, MD^c,
Azeem Latib, MD^d,
Luis Nombela-Franco, MD^e,
Enrique Gutiérrez-Ibanez, MD^f,
Gabriela Veiga-Fernandez, MD^g,
Asim N. Cheema, MD^h,
Ignacio Cruz-Gonzalez, MDⁱ,
Vicenç Serra, MD^j,
Corrado Tamburino, MD^b,
Antonio Mangieri, MD^d,
Antonio Colombo, MD^d,
Pilar Jiménez-Quevedo, MD^e,
Jaime Elizaga, MD^f,
Gerard Laughlin, MD^f,
Dae-Hyun Lee, MD^g,
Bruno Garcia del Blanco, MD^j,
Tania Rodriguez-Gabella, MD^a,
Josep-Ramon Marsal, MSc^j,
Mélanie Côté, MSc^a,
François Philippon, MD^a and
Josep Rodés-Cabau, MD^a,^∗ (josep.rodes{at}criucpq.ulaval.ca)

^aQuebec Heart & Lung Institute, Laval University, Quebec City, Canada
^bFerrarotto Hospital, University of Catania, Catania, Italy
^cHospital Universitario Virgen de la Victoria, Málaga, Spain
^dSan Raffaele Scientific Institute, Milan, Italy
^eInstituto Cardiovascular, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Madrid, Spain
^fHospital Gregorio Marañon, Madrid, Spain
^gHospital Universitario Marques de Valdecilla, Santander, Spain
^hSt-Michael’s Hospital, Toronto University, Toronto, Canada
ⁱHospital Universitario de Salamanca, Salamanca, Spain
^jHospital Universitari Vall d’Hebron, Barcelona, Spain

↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Sainte-Foy, Québec City, Québec, Canada.

Graphical abstract

Abstract

Objectives This study sought to evaluate the long-term clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR).

Background Conduction disturbances leading to PPI are common following TAVR. However, no data exist regarding the impact of PPI on long-term outcomes post-TAVR.

Methods This was a multicenter study including a total of 1,629 patients without prior PPI undergoing TAVR (balloon- and self-expandable valves in 45% and 55% of patients, respectively). Follow-up clinical, echocardiographic, and pacing data were obtained at a median of 4 years (interquartile range: 3 to 5 years) post-TAVR.

Results PPI was required in 322 (19.8%) patients within 30 days post-TAVR (26.9% and 10.9% in patients receiving self- and balloon-expandable CoreValve and Edwards systems, respectively). Up to 86% of patients with PPI exhibited pacing >1% of the time during follow-up (>40% pacing in 51% of patients). There were no differences between patients with and without PPI in total mortality (48.5% vs. 42.9%; adjusted hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 0.95 to 1.39; p = 0.15) and cardiovascular mortality (14.9% vs. 15.5%, adjusted HR: 0.93; 95% CI: 0.66 to 1.30; p = 0.66) at follow-up. However, patients with PPI had higher rates of rehospitalization due to heart failure (22.4% vs. 16.1%; adjusted HR: 1.42; 95% CI: 1.06 to 1.89; p = 0.019), and the combined endpoint of mortality or heart failure rehospitalization (59.6% vs. 51.9%; adjusted HR: 1.25; 95% CI: 1.05 to 1.48; p = 0.011). PPI was associated with lesser improvement in LVEF over time (p = 0.051 for changes in LVEF between groups), particularly in patients with reduced LVEF before TAVR (p = 0.005 for changes in LVEF between groups).

Conclusions The need for PPI post-TAVR was frequent and associated with an increased risk of heart failure rehospitalization and lack of LVEF improvement, but not mortality, after a median follow-up of 4 years. Most patients with new PPI post-TAVR exhibited some degree of pacing activity at follow-up.

Key Words

Footnotes

Dr. Chamandi has received a fellowship grant from Edwards Lifesciences. Dr. Barbanti has served as a consultant for Edwards Lifesciences. Dr. Latib has served on the advisory board for Medtronic; and received honoraria from Abbott Vascular. Dr. Nombela-Franco has served as a proctor for St. Jude Medical. Dr. Rodriguez-Gabella was supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Canadian Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.