Post-TAVR Pacemakers Linked to Higher Mortality Risk

Permanent pacemaker (PPM) implantation soon after transcatheter aortic valve replacement (TAVR) often leads to worse outcomes, according to a new study.

Researchers at the Reading Health System (West Reading, PA, USA), Thomas Jefferson University (TJU; Philadelphia, PA, USA), and other institutions conducted a retrospective cohort study of 9,785 patients undergoing TAVR in the United States at 229 sites between November 2011 and September 2014. Of these, 651 needed a permanent pacemaker within 30 days of the TAVR procedure. The researchers then used the data to evaluate the incidence, predictors, and clinical outcomes of PPM implantation following TAVR.

The results showed that PPM needs varied among those receiving self-expanding valves (25.1%) versus balloon-expanding valves (4.3%). Positive predictors of PPM implantation were age, prior conduction defect, and use of self-expanding valve. PPM implantation was also associated with longer median hospital stay, intensive care unit (ICU) stay, increased mortality, and a composite of mortality or heart failure admission at one year, but not with heart failure admission alone. The study was published in the November 2106 issue of JACC: Cardiovascular Interventions.

“While pacemakers can and do help save lives, what our study shows is that when they are placed within a month post-TAVR, they may be associated with worsened outcomes as compared to those who did not need pacemakers,” said lead author Opeyemi Fadahunsi, MBBS, MPH, of Reading Health System. “While TAVR is a great advance in medical care, cardiologists need to better understand both how to prevent patients from developing heart rhythm problems, and why patients who need pacemakers in the setting of recent TAVR have worsened outcomes.”

The percutaneous treatment of severe aortic valve disease using a TAVR prosthetic aortic valve replacement, without the need for open-heart surgery or cardiopulmonary bypass, is faster and less invasive than current open-heart procedures. TAVR has so far been proven effective in high-risk and inoperable patients, and could soon become the standard of care, even in moderate and low surgical risk patients.

Related Links:
Reading Health System
Thomas Jefferson University