Prognostic Role of Ventricular Pacing Burden in Patients with Pacemaker Implantation After TAVR

Creative Commons License

DEMİRTAŞ A. O., Yildirim A., Coskun M., Ozdemir H. B., Sezici E., KURT İ. H.

Medicina (Lithuania), cilt.61, sa.10, 2025 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 61 Sayı: 10
  • Basım Tarihi: 2025
  • Doi Numarası: 10.3390/medicina61101758
  • Dergi Adı: Medicina (Lithuania)
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
  • Anahtar Kelimeler: transcatheter aortic valve replacement, TAVR, permanent pacemaker, ventricular pacing, conduction disturbances, atrioventricular block
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

Background and Objectives: Permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) is common, yet the prognostic implications of ventricular pacing (VP) burden remain uncertain. Materials and Methods: We retrospective single-center cohort study included 118 patients undergoing TAVR who required new PPM implantation. Using X-tile analysis, patients were stratified into two groups, VP < 85% and VP ≥ 85%, at 1 month. Baseline characteristics, post-procedural outcomes, echocardiographic parameters, and long-term endpoints were compared. The primary endpoint was all-cause mortality; the secondary endpoint was a composite of mortality and first heart failure (HF) hospitalization. Results: At 1 month, 73 patients (61.9%) had VP < 85% and 45 (38.1%) had VP ≥ 85%. Baseline demographics were similar, but patients with VP ≥ 85% had higher LVEF (59.4 ± 4.2 vs. 49.4 ± 6.7%, p < 0.001), lower creatinine (0.8 vs. 1.0 mg/dL, p = 0.016), and higher e-GFR (69.6 ± 20.6 vs. 60.4 ± 19.8, p = 0.017). Time to PPM implantation was shorter in the VP ≥ 85% group (2.6 ± 1.3 vs. 6.2 ± 2.6 days, p < 0.001). During a median follow-up of 315 ± 105 days, mortality did not differ between groups (HR: 1.81, 95% CI: 0.76–4.31, p = 0.182). However, VP ≥ 85% was associated with a higher incidence of the secondary endpoint (HR: 2.36, 95% CI: 1.21–4.58, p = 0.012). Echocardiographic follow-up revealed lower LVEF and higher e-SPAP at 1 year in the VP ≥ 85% group (both p < 0.001). Conclusions: In TAVR patients requiring PPM, a high VP burden (≥85%) was not associated with increased mortality but predicted a higher risk of HF hospitalization and deterioration in echocardiographic parameters.