Clinical effects of permanent pacemaker implantation after transcatheter aortic valve implantation: Insights from the nationwide FRANCE-TAVI registry
Résumé
BackgroundThe influence of permanent pacemaker implantation upon outcomes after transcatheter aortic valve implantation (TAVI) remains controversial.AimsTo evaluate the impact of permanent pacemaker implantation after TAVI on short- and long-term mortality, and on the risk of hospitalization for heart failure.MethodsData from the large FRANCE-TAVI registry, linked to the French national health single-payer claims database, were analysed to compare 30-day and long-term mortality rates and hospitalization for heart failure rates among patients with versus without permanent pacemaker implantation after TAVI. Multivariable regressions were performed to adjust for confounders.ResultsA total of 36,549 patients (mean age 82.6 years; 51.6% female) who underwent TAVI from 2013 to 2019 were included in the present analysis. Among them, 6999 (19.1%) received permanent pacemaker implantation during the index hospitalization, whereas 232 (0.6%) underwent permanent pacemaker implantation between hospital discharge and 30 days after TAVI, at a median of 11 (interquartile range: 7–18) days. In-hospital permanent pacemaker implantation was not associated with an increased risk of death between discharge and 30 days (adjusted odds ratio: 0.91, 95% confidence interval: 0.64–1.29). At 5 years, the incidence of all-cause death was higher among patients with versus without permanent pacemaker implantation within 30 days of the procedure (adjusted hazard ratio: 1.13, 95% confidence interval: 1.07–1.19). Permanent pacemaker implantation within 30 days of TAVI was also associated with a higher 5-year rate of hospitalization for heart failure (adjusted subhazard ratio: 1.17, 95% confidence interval: 1.11–1.23).ConclusionsPermanent pacemaker implantation after TAVI is associated with an increased risk of long-term hospitalization for heart failure and all-cause mortality. Further research to mitigate the risk of postprocedural permanent pacemaker implantation is needed as TAVI indications expand to lower-risk patients.