Latest Karolinska University Hospital News
Oct 7, 2021
Permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) may not have a negative impact on long-term patient outcomes, according to a new study published in JACC: Cardiovascular Interventions. “Risk factors for PPI following TAVR include self-expandable valves, deep prosthetic valve implantation, preprocedural conduction disturbances, older age, and a high number of comorbidities,” wrote lead author Andreas Rück, MD, PhD, a cardiologist at Karolinska University Hospital in Sweden, and colleagues. “Right ventricular pacing is associated with a reduced left ventricular ejection fraction and a higher degree of heart failure. However, the impact of permanent pacemaker implantation after TAVR is unknown, and prior studies have produced conflicting results. As the use of TAVR expands to include younger and low-risk patients with a long life expectancy, it will become increasingly important to understand the impact of permanent pacemaker implantation after TAVR.” The group focused on data from more than 3,400 TAVR patients who were treated from 2008 to 2018 in Sweden. The median follow-up period was 2.7 years. Of that group, 481 patients underwent PPI within 30 days of the procedure. Survival after one year, five years and 10 years for the group that underwent PPI was 90.1%, 52.7% and 10.9%, respectively. For patients who did not receive a pacemaker, those survival rates were 92.7%, 53.8% and 15.3%. The risk of cardiovascular death, heart failure or endocarditis were comparable between the two patient groups. Even though these findings suggest that PPI after TAVR may not impact a patient’s long-term health, Rück et al. did emphasize that researchers and clinicians should continue working to reduce the need for permanent pacemakers. “As the use of TAVR expands, the higher risk of requiring permanent pacemaker implantation after TAVR than after SAVR remains a concern,” they wrote. “It is thus important to find strategies to reduce the rate of pacemaker implantation after TAVR.” The authors also noted that “studies including younger and low-risk patients with longer follow-up are needed to confirm the present findings in these patient populations.” The full analysis is available here .