Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Heart Rhythm. 2022 Sep;19(9):1508-1515. doi: 10.1016/j.hrthm.2022.04.030. Epub 2022 May 4.
Conflicting data exist on the prognostic significance of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR).
The purpose of this study was to evaluate whether PPM implantation after TAVR is associated with adverse outcomes.
A retrospective analysis of a cohort comprised patients enrolled in a prospective registry between 2008 and 2019. Participants were allocated into 3 groups: patients without a prior pacemaker (n = 930 [75%]), those with previous pacemaker implantation (n = 118 [10%]), and those with pacemaker implantation after TAVR (n = 191 [15%]). The primary outcome included death and heart failure hospitalizations at 1 year. Secondary outcomes included death and heart failure hospitalizations stratified by pacing burden.
A total of 1239 patients underwent TAVR with a median follow-up period of 2.3 years (interquartile range 1-4 years). Patients with previous and new pacemaker implantation were older (84 [80-88], 84 [80-88], and 82 [78-86] years; P = .009) and had lower baseline left ventricular ejection fraction (50% ± 15%, 55% ± 12%, and 56% ± 12%; P < .001). Patients who underwent new pacemaker implantation had higher combined outcome of death and heart failure hospitalizations (21%,12%, and 14%; P = .01). New pacemaker implantation was associated with almost twice the risk of 1-year mortality (odds ratio 1.85; 95% confidence interval 1.13-3.02; P = .014). Pacing burden, however, was not associated with the primary outcome. Furthermore, no significant difference was observed at long-term follow-up (cumulative probability to develop the primary end point at 3 years was 57% ± 2% [without PPM], 57% ± 6% [prior PPM], 54% ± 4% [new PPM]; P = .52).
Pacemaker implantation after TAVR is associated with higher 1-year adverse outcome, but this attenuates over time, suggesting that competing factors may play a role. Interestingly, pacing burden is not associated with adverse clinical course.
经导管主动脉瓣置换术（TAVR）后植入永久性起搏器（PPM）的预后意义存在矛盾的数据。
本研究旨在评估 TAVR 后植入 PPM 是否与不良结局相关。
对 2008 年至 2019 年期间入组前瞻性注册研究的队列进行回顾性分析。参与者被分为 3 组：无先前起搏器的患者（n = 930 [75%]）、先前植入起搏器的患者（n = 118 [10%]）和 TAVR 后植入起搏器的患者（n = 191 [15%]）。主要结局包括 1 年时的死亡和心力衰竭住院。次要结局包括按起搏负担分层的死亡和心力衰竭住院。
共 1239 例患者接受了 TAVR，中位随访时间为 2.3 年（四分位距 1-4 年）。先前和新植入起搏器的患者年龄更大（84 [80-88]、84 [80-88]和 82 [78-86]岁；P =.009），基线左心室射血分数更低（50% ± 15%、55% ± 12%和 56% ± 12%；P <.001）。新植入起搏器的患者死亡和心力衰竭住院的联合结局更高（21%、12%和 14%；P =.01）。新植入起搏器与 1 年死亡率几乎增加了两倍的风险（比值比 1.85；95%置信区间 1.13-3.02；P =.014）。然而，起搏负担与主要结局无关。此外，在长期随访中未观察到显著差异（3 年时发生主要终点的累积概率为 57% ± 2%[无 PPM]、57% ± 6%[先前 PPM]、54% ± 4%[新 PPM]；P =.52）。
TAVR 后植入起搏器与更高的 1 年不良结局相关，但随着时间的推移这种相关性减弱，这表明竞争因素可能起作用。有趣的是，起搏负担与不良临床过程无关。
