Permanent pacemaker implantation before or after TAVR linked to worse outcomes
Permanent pacemaker implantation (PPM) before or up to 30 days after transcatheter aortic valve replacement (TAVR) is associated with an increased risk of death or heart failure hospitalization, according to a new study published in Heart Rhythm.
“TAVR has become an indispensable treatment in selected symptomatic patients presenting with aortic stenosis,” wrote lead author Nicolas Clementy, MD, PhD, a cardiologist at the University of Tours in France, and colleagues. “Conduction abnormalities following TAVR are commonly reported and often may require PPM, but little is known about its potential consequences on outcomes in this population.”
Clementy et al. tracked data from all TAVR procedures performed in France from 2010 to 2019. The team’s evaluation included more than 49,000 patients who underwent TAVR after being hospitalized for severe aortic stenosis. Follow-up data from at least six months later were available for more than 29,000 of those patients. While 22% of that group had PPM at baseline, an additional 22% underwent post-TAVR PPM within 30 days.
Patients with baseline PPM and post-TAVR PPM all faced a higher risk of all-cause mortality and hospitalization for heart failure, the group reported.
“We are in need of more accurate screening algorithms that determine the optimal indications for PPM in the post-TAVR population and evaluate alternative pacing approaches when PPM cannot be avoided,” Clementy and colleagues wrote. “The higher risk of PPM with TAVR compared with conventional surgery also will have to be considered in lower-risk patients.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.