1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland
Background and Aims:
Conduction disturbances after transfemoral transcatheter aortic valve implantation (tf TAVI) are still frequent. Depending on the TAVI prosthesis, 7 to 20% of patients require permanent pacemaker implantation within the same hospital stay. According to the recommendations of the 2021 ESC guideline on cardiac pacing, there are 5 scenarios for the management of conduction abnormalities in patients after TAVI, e.g., pacemaker implantation in the case of persistent high degree atrioventricular (AV) block or new onset of alternating bundle branch block (BBB).
Aim of the current study was to record pacing rates during follow-up in tf TAVI patients that underwent permanent pacemaker implantation within the same hospital stay. Indications were provided in association to current guideline recommendations.
Methods and Results:
Between 2017 and 2022, 943 patients (mean age: 79±7 years; 45% female; mean STS score: 4.7±3.6) were prospectively included in our real-world single center registry (Jenaer Aortenklappenregister, JAKR). In 122 patients (12.94%; mean age: 80±6 years; 34% female; mean STS score: 4.1±2.7), a permanent pacemaker was implanted within the hospitalization for TAVI. From these patients, 85 (69.7%) were implanted due to 3rd degree AV block, 5 (4.1%) due to new onset BBB, 2 (1.6%) due to pre-existing right BBB with new post-procedure conduction disturbance, 22 (18%) due to persistent new left BBB with further prolongation within 72 hours, 5 (4.1%) due to pre-existing conduction abnormalities with relevant QRS or PR prolongation within 72 hours and 3 patients (2.5%) due to other indications. During follow-up, the mean ventricular pacing (VP) rate of all pacemaker patients was 57±43%. There were no significant differences in VP rate between the above-mentioned indication groups (p=0.794). When comparing the pacemaker rates over time, there were significant differences ranging from 5% to 18% per year (p=0.005). There were no differences in VP rates during follow-up between the years of pacemaker implantation (p=0.657). In 20 patients (16.4%), VP rates were ≤ 1% during follow-up indicating no relevant pacemaker dependence. When comparing these patients to those with VP rates > 1%, there were no relevant differences regarding indication groups (p=0.743).
Conclusions:
Pacemaker implantation after TAVI in our registry show varying numbers between the years of implantation. The VP rates during follow-up can be suggested as rough measure for indication quality regarding pacemaker implantation after TAVI within the same hospital stay. Since there were no differences in VP rates over the years (despite varying frequency of pacemaker implantation) and between the indication groups, indication quality can be considered high. Nevertheless, a relevant proportion of patients showed VP rates ≤ 1% and thus probably do not benefit from pacemaker implantation. The way of identification of these patients remains challenging and should be the object of further studies.