Effect of pacemaker implantation after transcatheter aortic valve replacement on long- and mid-term mortality

Background: Transcatheter aortic valve replacement (TAVR) has become quite common. Atrioventricular conduction defects remain a frequent complication resulting with permanent pacemaker (PPM) implantation. Past studies showed conflicting results regarding PPM effect on mortality. Objective: The purpose of this study was to assess the influence of PPM implantation on mid- and long-term mortality in a large cohort of patients who underwent TAVR. Methods: Patients undergoing TAVR between 2009 and 2019 were categorized into groups: no PPM implanted (no-PPM), PPM implanted before the procedure (pre-PPM), and PPM implanted postprocedure (post-PPM). All-cause mortality up to 6 years was compared. Subanalyses were performed according to pacing burden. Proportion of patients who had decreased left ventricular ejection fraction within 1 year of the procedure after TAVR was also recorded. Results: A total of 1489 patients were followed. Unadjusted mortality was similar for patients regardless of PPM status within 12 months (P >.187), yet within 72 months, mortality was similar for the post-PPM (P =.257) and higher for pre-PPM (hazard ratio 1.53; P =.002) groups. Analysis adjusted by clinical characteristics did not show any independent long- or mid-term survival effects of PPM (P >.563). Analysis according to pacing burden showed no significant mortality difference (P >.8). Analysis of post-PPM patients with “high” or “near constant” (>40%) pacing burden vs no-PPM patients showed similar mortality for both mid- and long-term mortality (P =.055 and P =.513). Left ventricular ejection fraction decrease within 1 year was more common in both PPM groups, with a higher proportion with higher pacing burden (P <.001). Conclusion: This cohort of consecutive patients undergoing TAVR showed that postprocedure PPM was not associated with increased long-term mortality. This conclusion was not altered by ventricular pacing burden.