TY - JOUR
T1 - Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation
AU - Bruno, Francesco
AU - Munoz Pousa, Isabel
AU - Saia, Francesco
AU - Vaira, Matteo Pio
AU - Baldi, Enrico
AU - Leone, Pier Pasquale
AU - Cabanas-Grandio, Pilar
AU - Corcione, Nicola
AU - Spinoni, Enrico Guido
AU - Annibali, Gianmarco
AU - Russo, Caterina
AU - Ziacchi, Matteo
AU - Caruzzo, Carlo Alberto
AU - Ferlini, Marco
AU - Lanzillo, Giuseppe
AU - De Filippo, Ovidio
AU - Dusi, Veronica
AU - Gallone, Guglielmo
AU - Castagno, Davide
AU - Patti, Giuseppe
AU - La Torre, Michele
AU - Musumeci, Giuseppe
AU - Giordano, Arturo
AU - Stefanini, Giulio
AU - Salizzoni, Stefano
AU - Conrotto, Federico
AU - Rinaldi, Mauro
AU - Rordorf, Roberto
AU - Abu-Assi, Emad
AU - Raposeiras-Roubin, Sergio
AU - Biffi, Mauro
AU - D'Ascenzo, Fabrizio
AU - De Ferrari, Gaetano Maria
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/5/8
Y1 - 2023/5/8
N2 - Background: Long-term right ventricular pacing (VP) has been related to negative left ventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients. Objectives: The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR. Methods: PACE-TAVI is an international multicenter registry of all consecutive TAVR patients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF. Results: A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP ≥40%. After multivariable adjustment, VP ≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P = 0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P = 0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P = 0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80-5.90; P = 0.13). Patients with VP ≥ 40% showed a higher New York Heart Association functional class both at 1 year (P = 0.009) and at last available follow-up (P = 0.04) and a nonsignificant reduction of left ventricular ejection fraction (P = 0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P = 0.009). Conclusions: In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization. These findings suggest the opportunity to minimize right VP through dedicated algorithms in post-TAVR patients without complete atrioventricular block and to evaluate a more physiological VP modality in patients with persistent complete atrioventricular block.
AB - Background: Long-term right ventricular pacing (VP) has been related to negative left ventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients. Objectives: The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR. Methods: PACE-TAVI is an international multicenter registry of all consecutive TAVR patients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF. Results: A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP ≥40%. After multivariable adjustment, VP ≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P = 0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P = 0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P = 0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80-5.90; P = 0.13). Patients with VP ≥ 40% showed a higher New York Heart Association functional class both at 1 year (P = 0.009) and at last available follow-up (P = 0.04) and a nonsignificant reduction of left ventricular ejection fraction (P = 0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P = 0.009). Conclusions: In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization. These findings suggest the opportunity to minimize right VP through dedicated algorithms in post-TAVR patients without complete atrioventricular block and to evaluate a more physiological VP modality in patients with persistent complete atrioventricular block.
KW - heart failure
KW - permanent pacemaker implantation
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85153797022&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2023.02.003
DO - 10.1016/j.jcin.2023.02.003
M3 - Article
SN - 1936-8798
VL - 16
SP - 1081
EP - 1091
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -