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

Abstract Atrioventricular conduction disturbances requiring implantation of permanent pacemaker (PPM) are a common complication following transcatheter aortic valve implantation (TAVI). Prior registry data is 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 2011-2017 out of which 146 underwent PPM. Follow up one-year post TAVI outcome data was available for 55 patients and was analyzed retrospectively. Patients who underwent PPM were more likely to have heart failure admissions (17.1% vs 10.1%; HR 1.70; 95% CI 1.10-2.64; P 0.019) and a trend towards increased mortality (21.9% vs 15.4%; HR 1.42; 95% CI 0.99-2.05; P 0.062). At 1 year follow up 30/55 (54.5%) patients demonstrated greater than 40% RV pacing. Compared to patients who had 40% RV pacing were more likely to have heart failure admissions (8% vs 40%; HR 5.0; 95% CI 1.23-20.27; P 0.007) and demonstrated a trend towards increased mortality (12% vs 33.3%; HR 2.78; 95% CI 0.86-9.00; P 0.064). This is suggestive that the post TAVI PPM cohort is particularly sensitive to chronic RV pacing.