Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
JACC Cardiovasc Interv. 2021 Oct 11;14(19):2173-2181. doi: 10.1016/j.jcin.2021.07.043.
This study was performed to investigate long-term, clinically important outcomes in patients who underwent permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR).
The impact of permanent pacemaker implantation after TAVR is unknown, and prior studies have produced conflicting results.
In this nationwide, population-based cohort study, the study included all patients who underwent transfemoral TAVR in Sweden from 2008 to 2018 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. Additional baseline characteristics and information about outcomes were obtained by individual crosslinking with other national health data registers. Unadjusted and multivariable-adjusted analyses were performed using Cox proportional hazards regression.
Of 3,420 patients, 481 (14.1%) underwent permanent pacemaker implantation within 30 days after TAVR. The survival rate at 1, 5, and 10 years was 90.0%, 52.7%, and 10.9% in the pacemaker group and 92.7%, 53.8%, and 15.3% in the nonpacemaker group, respectively (HR: 1.03; 95% CI: 0.88-1.22; P = 0.692). The median follow-up was 2.7 years (interquartile range: 2.5, and maximum 11.8 years). There was no difference in the risk of cardiovascular death (HR: 0.91; 95% CI: 0.71-1.18; P = 0.611), heart failure (HR: 1.23; 95% CI: 0.92-1.63; P = 0.157), or endocarditis (HR: 0.90; 95% CI: 0.47-1.69; P = 0.734) between the groups.
The study found no difference in long-term survival between patients who did and did not undergo permanent pacemaker implantation after TAVR. As the use of TAVR expands to include younger and low-risk patients with a long life expectancy, it will become increasingly important to understand the impact of permanent pacemaker implantation after TAVR.
本研究旨在探讨经导管主动脉瓣置换术（TAVR）后行永久性心脏起搏器植入患者的长期临床重要结局。
TAVR 后行永久性心脏起搏器植入的影响尚不清楚，先前的研究结果存在矛盾。
在这项全国范围内基于人群的队列研究中，研究纳入了 2008 年至 2018 年在瑞典接受经股 TAVR 的所有患者，数据来自 SWEDEHEART（瑞典心脏治疗的增强和发展的基于证据的网络系统）登记处。通过与其他国家健康数据登记处的个体交叉链接，获得了额外的基线特征和结局信息。使用 Cox 比例风险回归进行未调整和多变量调整分析。
在 3420 名患者中，481 名（14.1%）在 TAVR 后 30 天内植入了永久性心脏起搏器。在起搏器组和非起搏器组中，1 年、5 年和 10 年的生存率分别为 90.0%、52.7%和 10.9%和 92.7%、53.8%和 15.3%（HR：1.03；95%CI：0.88-1.22；P=0.692）。中位随访时间为 2.7 年（四分位距：2.5，最长 11.8 年）。两组间心血管死亡（HR：0.91；95%CI：0.71-1.18；P=0.611）、心力衰竭（HR：1.23；95%CI：0.92-1.63；P=0.157）或感染性心内膜炎（HR：0.90；95%CI：0.47-1.69；P=0.734）的风险无差异。
本研究发现 TAVR 后行永久性心脏起搏器植入与未植入患者的长期生存率无差异。随着 TAVR 的应用扩展到预期寿命较长的年轻和低危患者，了解 TAVR 后永久性心脏起搏器植入的影响将变得越来越重要。
