Impact of Early Versus Delayed Permanent Pacemaker Implantation on Clinical Outcomes in Patients With Third-Degree Atrioventricular Block After Transcatheter Aortic Valve Replacement: A National Inpatient Sample Analysis

Abstract

Background

Third-degree atrioventricular (AV) block following transcatheter aortic valve replacement (TAVR) often necessitates permanent pacemaker (PPM) implantation. However, the impact of PPM timing on clinical outcomes remains unclear.

Methods

Utilizing the National Inpatient Sample (2016–2021), we identified third-degree AV block patients who received PPM during the same admission period after TAVR. Cohorts were defined as early (≤ 72 h) or delayed (> 72 h) implantation. In-hospital mortality constituted the primary endpoint, while the duration of hospitalization and the costs incurred were designated as secondary endpoints. Multivariable logistic regression was employed to calculate adjusted odds ratios (aOR) or adjusted beta (aβ).

Results

In an adjusted analysis of 3385 patients exhibiting third-degree AV block post-TAVR who underwent PPM implantation, no significant variation in in-hospital mortality was detected between the two cohorts (aOR 1.25, 95% CI 0.59–2.66), but the delayed group experienced a 6.30-day longer LOS (aβ: 6.30; 95% CI, 5.96–6.63) and incurred $81,572.80 more in hospitalization costs (aβ: 81,572.8; 95% CI 69,542.5–93,606.1). Delayed PPM implantation was more likely in patients with anemia, coagulation disorders, congestive heart failure, or chronic kidney disease (all p < 0.001).

Conclusion

In this national cohort, delayed PPM implantation after TAVR-related AV block was associated with longer stays and higher costs, but not with mortality. This delay was more frequent among patients with baseline hematological and cardiorenal dysfunction.