Conduction System Versus Right Ventricular Pacing in Patients Undergoing TAVR

IF 12.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2026-10-12 DOI:10.1016/j.jcin.2026.08.008

Felipe Diez-Delhoyo MD, Jorge Sanz-Sanchez MD, PhD, Guillem Muntane-Carol MD, Ignacio Jesus Amat-Santos MD, PhD, Juan Francisco Oteo Dominguez MD, Ricardo Rivera-Lopez MD, PhD, Lluis Asmarats MD, Manuel Pan MD, PhD, Jose Maria Novoa Medina MD, Juan Antonio Franco-Pelaez MD, Carlos Cuellas MD, Jessica Roa-Garrido MD, Maria Tamargo MD, PhD, Gabriela Veiga MD, Marta Herrero-Brocal MD, Pablo Miguel Valentin Garcia MD, Juan Garcia-Lara MD, Javier Cuesta MD, PhD, Felix Valencia-Serrano MD, Raquel Pimienta-Gonzalez MD, Fernando Sarnago Cebada MD

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引用次数: 0

Abstract

Background

Pacemaker implantation after transcatheter aortic valve replacement (TAVR) is common and has been associated with adverse clinical outcomes. Cardiac physiological pacing (CPP) may preserve ventricular synchrony and reduce heart failure (HF) events compared with right ventricular pacing (RVP).

Objectives

This study sought to compare long-term clinical outcomes of CPP vs RVP in patients requiring permanent pacing after TAVR.

Methods

Registro de Estimulación Fisiológica-TAVR is a retrospective, multicenter nationwide registry including patients undergoing TAVR and pacemaker implantation within 30 days. Propensity score matching (1:1) was performed using baseline clinical and echocardiographic variables, yielding 466 matched pairs. The primary endpoint was the composite of cardiovascular death or HF hospitalization. Cox proportional hazards models were used for time-to-event analyses. Median follow-up was 24 months.

Results

In the propensity score–matched cohort, CPP was associated with a lower incidence of the primary endpoint than RVP (9.7% vs 17.6%; HR: 0.57; 95% CI: 0.39-0.83; P = 0.003). This difference was driven by fewer HF hospitalizations (7.9% vs 13.9%; HR: 0.57; 95% CI: 0.37-0.86; P = 0.008). No significant differences were observed in cardiovascular death or all-cause mortality between groups.

Conclusions

In this multicenter propensity score–matched study, CPP after TAVR was associated with a lower risk of the primary endpoint, driven by fewer HF hospitalizations. These findings support the need for further randomized clinical trials to evaluate the role of CPP in post-TAVR patients requiring ventricular pacing.

查看原文本刊更多论文

传导系统与TAVR患者右心室起搏：一项多中心倾向匹配研究。

背景：经导管主动脉瓣置换术（TAVR）后起搏器植入是常见的，并且与不良的临床结果相关。与右心室起搏（RVP）相比，心脏生理起搏（CPP）可以保持心室同步并减少心力衰竭（HF）事件。目的：本研究旨在比较TAVR术后需要永久起搏的患者的CPP和RVP的长期临床结果。方法：Registro de Estimulación Fisiológica-TAVR是一个回顾性的、多中心的全国性登记，包括30天内接受TAVR和起搏器植入的患者。使用基线临床和超声心动图变量进行倾向评分匹配（1:1），产生466对匹配。主要终点为心血管死亡或心衰住院。Cox比例风险模型用于时间-事件分析。中位随访时间为24个月。结果：在倾向评分匹配的队列中，与RVP相比，CPP与主要终点的发生率较低（9.7% vs 17.6%; HR: 0.57; 95% CI: 0.39-0.83; P = 0.003）。这种差异是由较少的心衰住院造成的（7.9% vs 13.9%; HR: 0.57; 95% CI: 0.37-0.86; P = 0.008）。两组间心血管死亡或全因死亡率无显著差异。结论：在这项多中心倾向评分匹配的研究中，TAVR后的CPP与主要终点的风险较低相关，这是由较少的HF住院所致。这些发现支持需要进一步的随机临床试验来评估CPP在tavr后需要心室起搏的患者中的作用。

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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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.