Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve ReplacementAnalysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry
Author + information
- Opeyemi O. Fadahunsi, MBBS, MPHa,∗ (yemi.fadahunsi{at}nshealth.ca),
- Abiola Olowoyeye, MD, MPHb,
- Anene Ukaigwe, MDa,c,
- Zhuokai Li, PhDd,
- Amit N. Vora, MD, MPHd,
- Sreekanth Vemulapalli, MDd,
- Eric Elgin, MDe,f and
- Anthony Donato, MD, MHPEa,f
- aDepartment of Medicine, Reading Health System, West Reading, Pennsylvania
- bChildren’s Hospital Los Angeles, Los Angeles, California
- cDivision of Cardiology, Hershey Medical Center, Hershey, Pennsylvania
- dDuke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- eDivision of Cardiology, Cardiology Associates of West Reading, West Reading, Pennsylvania
- fJefferson Medical College, Philadelphia, Pennsylvania
- ↵∗Reprint requests and correspondence:
Dr. Opeyemi Fadahunsi, Department of Medicine, Reading Health System, Sixth Avenue and Spruce Street, West Reading, Pennsylvania 19611.
Graphical abstract
Abstract
Objectives 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).
Background 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.
Methods 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.
Results 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).
Conclusions 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.
Footnotes
This research was supported by the American College of Cardiology Foundation’s STS/ACC TVT Registry. The views expressed in this paper represent those of the authors and do not necessarily represent the official views of the STS/ACC TVT Registry or its associated professional societies, identified at https://www.ncdr.com/WebNCDR/tvt/home. Dr. Vemulapalli has received consulting fees and honoraria from Novella and Premiere; has received travel reimbursement from Abbott Vascular and Philips Medical Systems; and has received research grants from Abbott Vascular, the Agency for Healthcare Research and Quality, the American College of Cardiology, and Boston Scientific. Dr. Vora was funded by National Institutes of Health T-32 training grant T32 HL069749 and L30 HL124592. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 20, 2016.
- Accepted July 14, 2016.
- American College of Cardiology Foundation
