Clinical impact of right ventricular pacing burden in patients with post-transcatheter aortic valve replacement permanent pacemaker implantation

Aims Patients who undergo permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) have a worse outcome. The aim of this study was to identify risk factors of worse outcomes in patients with post-TAVR PPM implantation. Methods and results This is a single-centre, retrospective study of consecutive patients who underwent post-TAVR PPM implantation from 11 March 2011 to 9 November 2019. Clinical outcomes were evaluated by landmark analysis with cut-off at 1 year after the PPM implantation. Of the 1389 patients underwent TAVR during the study duration and a total of 110 patients were included in the final analysis. Right ventricular pacing burden (RVPB) >= 30% at 1 year was associated with a higher likelihood of heart failure (HF) readmission [adjusted hazard ratio (aHR): 6.333; 95% confidence interval [CI]: 1.417-28.311; P = 0.016] and composite endpoint of overall death and/or HF (aHR: 2.453; 95% CI: 1.040-5.786; P = 0.040). The RVPB >= 30% at 1 year was associated with higher atrial fibrillation burden (24.1 +/- 40.6% vs. 1.2 +/- 5.3%; P = 0.013) and a decrease in left ventricular ejection fraction (-5.0 +/- 9.8% vs. + 1.1 +/- 7.9%; P = 0.005). The predicting factors of the RVPB >= 30% at 1 year were the presence of RVPB >= 40% at 1 month and the valve implantation depth measured from non-coronary cusp >= 4.0 mm (aHR: 57.808; 95% CI: 12.489-267.584; P < 0.001 and aHR: 6.817; 95% CI: 1.829-25.402; P = 0.004). Conclusions The RVPB >= 30% at 1 year was associated with worse outcomes. Clinical benefit of minimal RV pacing algorithms and biventricular pacing needs to be investigated.

Automated summary

This study aimed to identify risk factors for worse outcomes in patients with post-TAVR PPM implantation. The results showed that a right ventricular pacing burden (RVPB) >= 30% at 1 year was associated with a higher likelihood of heart failure readmission and a composite endpoint of overall death and/or heart failure. Predicting factors for RVPB >= 30% at 1 year included RVPB >= 40% at 1 month and valve implantation depth measured from the non-coronary cusp >= 4.0 mm.