Pacemaker Placement After TAVR Associated with Worse Outcomes

For patients who have undergone a transcatheter aortic valve replacement (TAVR), placement of a permanent pacemaker (PPM) leads to longer hospital stays and increased risk of death than those who do not require a pacemaker, according to a new study.

TAVR is a minimally invasive procedure that is believed to reduce the risks associated with open-heart surgery. However, heart rhythm problems that require implantation of a PPM are common after a TAVR, and it is unknown whether implantation can be predicted or can lead to adverse events.
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Using the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and the Centers for Medicare and Medicaid Services database, the researchers assessed patients undergoing TAVR at 229 sites in the United States from November 2011 to September 2014.

Of the 9785 patients included in the study, 6.7% had a PPM implanted within 30 days of TAVR. Age, prior conduction defect, and use of self-expanding valve were positive predictors of PPM implantation.

Implantation was associated with longer median hospital stay, longer intensive care unit stay, increased all-cause mortality, and increased mortality or heart failure admission combined at 1 year but not with heart failure admission alone.

“Early PPM implantation is a common complication following TAVR, and it is associated with higher mortality and a composite of mortality or heart failure admission at 1 year,” the researchers concluded.

—Amanda Balbi

Reference:

Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT registry. JACC Cardiovasc Intervent. 2016;21(9):2189-2199. http://www.sciencedirect.com/science/article/pii/S1936879816311864. Accessed November 8, 2016.