Pacemaker implantation after surgical aortic valve replacement and balloon-expandable transcatheter aortic valve implantation: Incidence, predictors, and prognosis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-03-01 DOI:10.1016/j.hroo.2025.01.001

Davide Gabbieri MD, PhD , Italo Ghidoni MD , Greta Mascheroni MD , Matteo Chiarabelli RN, MSN , Giuseppe D’Anniballe MD , Paolo Pisi MD , Marco Meli MD , Clorinda Labia MD , Alice Barbieri CP , Francesca Spina CP , Federico Giorgi MD

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Abstract

Background

Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remains a significant challenge despite new-generation devices.

Objectives

This study aimed to identify predictors of PPI during preoperative evaluation and assess its mid-term impact in a single-center, real-world setting.

Methods

From 2010 to 2020, 1486 patients with aortic stenosis underwent surgical aortic valve replacement or TAVI using balloon-expandable transcatheter heart valves. The PPI rate was estimated using the hospital discharge record for each patient in the Emilia-Romagna region.

Results

The 30-day incidence of PPI in the TAVI group was 3.4%. While 30-day PPI did not affect overall survival (log-rank, P = .494 NS), it predicted rehospitalization due to cardiac causes (hazard ratio 10.28; 95% confidence interval [CI] 95% 3.41–31.00; P <.001). Calcifications in the leaflet (odds ratio [OR] 4.66; 95% CI 1.41–15.47; P = .012), left ventricular outflow tract (OR 4.51; 95% CI 1.48–13.76; P = .008), and device landing zone (OR 2.52; 9% CI 0.86–7.40; P = .093) were associated with a higher risk of PPI.

Conclusion

A low 30-day PPI incidence was observed, primarily because of the exclusive use of balloon-expandable SAPIEN transcatheter heart valves and high implantation techniques. Baseline factors such as leaflet, left ventricular outflow tract, and device landing zone calcifications, as well as right bundle branch block, highlight the need for comprehensive preoperative analysis to reduce PPI incidence and mitigate its associated longer hospital stays and rehospitalizations due to cardiac causes.

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主动脉瓣置换术后起搏器植入和经导管球囊扩张主动脉瓣植入：发生率、预测因素和预后

尽管有新一代的心脏起搏器，经导管主动脉瓣植入术（TAVI）后的永久性起搏器植入术（PPI）仍然是一个重大的挑战。目的本研究旨在确定术前评估时PPI的预测因素，并在单中心真实环境中评估其中期影响。方法2010年至2020年，1486例主动脉瓣狭窄患者行经导管球囊扩张心脏瓣膜置换术或TAVI。使用艾米利亚-罗马涅地区每位患者的出院记录估计PPI率。结果TAVI组30天PPI发生率为3.4%。虽然30天PPI不影响总生存期（log-rank, P = .494 NS），但它预测心脏原因导致的再住院(危险比10.28；95%置信区间[CI] 95% 3.41 ~ 31.00；P & lt;措施)。小叶钙化(优势比[OR] 4.66；95% ci 1.41-15.47；P = 0.012)，左心室流出道(OR 4.51；95% ci 1.48-13.76；P = 0.008)，器械着陆区(OR 2.52；9% ci 0.86-7.40；P = 0.093)与较高的PPI风险相关。结论30天PPI发生率较低，主要是由于采用球囊可膨胀的SAPIEN经导管心脏瓣膜和高植入技术。基线因素，如小叶、左心室流出道、器械着陆区钙化以及右束支阻滞，强调需要进行全面的术前分析，以减少PPI的发生率，减轻因心脏原因导致的相关住院时间延长和再住院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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