Impact of Right Ventricular Pacing in Patients Who Underwent Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation

Fahd Nadeem, Takahiro Tsushima, Thomas P. Ladas, Rahul B. Thomas, Sandeep M. Patel, Petar Saric, Toral Patel, Jerry Lipinski, Jun Li, Marco A. Costa, Daniel I. Simon, Ankur Kalra, Guillherme F. Attizzani, Mauricio S. Arruda, Judith Mackall, Sergio G. Thal

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Abstract

Atrioventricular conduction disturbances requiring implantation of permanent pacemaker (PPM) are a common complication following transcatheter aortic valve implantation (TAVI). Previous registry data are conflicting but suggestive of an increased risk in heart failure admissions in the post-TAVI PPM cohort. Given the expanding use of TAVI, the present study evaluates the effects of chronic right ventricular pacing (RV pacing) in post-TAVI patients. This is a single-center study of 672 patients who underwent TAVI from 2011 to 2017 of which 146 underwent PPM. Follow-up 1-year post-TAVI outcome data were available for 55 patients and were analyzed retrospectively. Patients who underwent PPM were more likely to have heart failure admissions (17.1% vs 10.1%; hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.10 to 2.64; p 0.019) and a trend toward increased mortality (21.9% vs 15.4%; HR 1.42; 95% CI 0.99 to 2.05; p 0.062). At 1-year follow-up, 30 of 55 (54.5%) patients demonstrated >40% RV pacing. Compared with patients who had <40% RV pacing, those with >40% RV pacing were more likely to have heart failure admissions (8% vs 40%; HR 5.0; 95% CI 1.23 to 20.27; p 0.007) and demonstrated a trend toward increased mortality (12% vs 33.3%; HR 2.78; 95% CI 0.86 to 9.00; p 0.064). This is suggestive that the post-TAVI PPM cohort is particularly sensitive to chronic RV pacing.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Confidence Intervals
Heart Failure
Mortality
Transcatheter Aortic Valve Replacement
Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Right Ventricular Pacing in Patients Who Underwent Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation. / Nadeem, Fahd; Tsushima, Takahiro; Ladas, Thomas P.; Thomas, Rahul B.; Patel, Sandeep M.; Saric, Petar; Patel, Toral; Lipinski, Jerry; Li, Jun; Costa, Marco A.; Simon, Daniel I.; Kalra, Ankur; Attizzani, Guillherme F.; Arruda, Mauricio S.; Mackall, Judith; Thal, Sergio G.

In: American Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Nadeem, F, Tsushima, T, Ladas, TP, Thomas, RB, Patel, SM, Saric, P, Patel, T, Lipinski, J, Li, J, Costa, MA, Simon, DI, Kalra, A, Attizzani, GF, Arruda, MS, Mackall, J & Thal, SG 2018, 'Impact of Right Ventricular Pacing in Patients Who Underwent Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2018.07.046
Nadeem, Fahd ; Tsushima, Takahiro ; Ladas, Thomas P. ; Thomas, Rahul B. ; Patel, Sandeep M. ; Saric, Petar ; Patel, Toral ; Lipinski, Jerry ; Li, Jun ; Costa, Marco A. ; Simon, Daniel I. ; Kalra, Ankur ; Attizzani, Guillherme F. ; Arruda, Mauricio S. ; Mackall, Judith ; Thal, Sergio G. / Impact of Right Ventricular Pacing in Patients Who Underwent Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation. In: American Journal of Cardiology. 2018.
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abstract = "Atrioventricular conduction disturbances requiring implantation of permanent pacemaker (PPM) are a common complication following transcatheter aortic valve implantation (TAVI). Previous registry data are conflicting but suggestive of an increased risk in heart failure admissions in the post-TAVI PPM cohort. Given the expanding use of TAVI, the present study evaluates the effects of chronic right ventricular pacing (RV pacing) in post-TAVI patients. This is a single-center study of 672 patients who underwent TAVI from 2011 to 2017 of which 146 underwent PPM. Follow-up 1-year post-TAVI outcome data were available for 55 patients and were analyzed retrospectively. Patients who underwent PPM were more likely to have heart failure admissions (17.1{\%} vs 10.1{\%}; hazard ratio [HR] 1.70; 95{\%} confidence interval [CI] 1.10 to 2.64; p 0.019) and a trend toward increased mortality (21.9{\%} vs 15.4{\%}; HR 1.42; 95{\%} CI 0.99 to 2.05; p 0.062). At 1-year follow-up, 30 of 55 (54.5{\%}) patients demonstrated >40{\%} RV pacing. Compared with patients who had <40{\%} RV pacing, those with >40{\%} RV pacing were more likely to have heart failure admissions (8{\%} vs 40{\%}; HR 5.0; 95{\%} CI 1.23 to 20.27; p 0.007) and demonstrated a trend toward increased mortality (12{\%} vs 33.3{\%}; HR 2.78; 95{\%} CI 0.86 to 9.00; p 0.064). This is suggestive that the post-TAVI PPM cohort is particularly sensitive to chronic RV pacing.",
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AU - Nadeem, Fahd

AU - Tsushima, Takahiro

AU - Ladas, Thomas P.

AU - Thomas, Rahul B.

AU - Patel, Sandeep M.

AU - Saric, Petar

AU - Patel, Toral

AU - Lipinski, Jerry

AU - Li, Jun

AU - Costa, Marco A.

AU - Simon, Daniel I.

AU - Kalra, Ankur

AU - Attizzani, Guillherme F.

AU - Arruda, Mauricio S.

AU - Mackall, Judith

AU - Thal, Sergio G.

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