Patients requiring a permanent pacemaker after TAVR face higher long-term risk of death
Patients who require a permanent pacemaker following transcatheter aortic valve replacement (TAVR) face significantly higher long-term risks of all-cause and cardiovascular mortality, according to new findings published in JACC: Cardiovascular Interventions.[1]
“As TAVR expands to include younger and low-risk patients with longer life expectancy, understanding the impact of pacemaker implantation following TAVR becomes increasingly important,” wrote first author Patrick Badertscher, MD, a cardiologist at University Hospital Basel in Switzerland, and colleagues.
Badertscher et al. explored data from the SwissTAVI registry, focusing on more than 13,000 TAVR patients who underwent treatment from February 2011 to June 2022 and were still alive 30 days following the procedure. The mean age was 82 years old, 47% of patients were women and the median follow-up period was more than two years. Also, 49.6% of patients received a balloon-expandable TAVR valve, 47.9% received a self-expanding valve and the final 2.5% received a mechanically expanding valve.
Overall, 15% of patients required a permanent pacemaker within 30 days of undergoing TAVR. These patients tended to be older, and were slightly more likely to be male, than those who did not require a pacemaker.
After one year, patients who required a permanent pacemaker had higher all-cause and cardiovascular mortality. The adjusted hazard ratios were 1.15 and 1.25, respectively, and these trends persisted for up to 10 years after treatment. After multivariable adjustments, the authors added, these patients who required a permanent pacemaker faced “significantly higher rates of cardiovascular mortality” and were more likely to experience left ventricular ejection fraction decline and/or severe heart failure symptoms.
“These findings underscore the need for further research aimed at reducing the incidence of pacemaker implantation after TAVR and mitigating its associated risks, especially in younger and to lower-risk patients,” the authors wrote.
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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.