1-year outcomes after conduction system pacing after transcatheter aortic valve implantation
T Serban, S Stortecky, P Krisai, S Knecht, C Huber, M Roffi, F Mahfoud, M Kuehne, C Sticherling, P BadertscherAbstract
Background
Studies comparing conduction system pacing (CSP) with conventional pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI) remain scarce.
Aim
To evaluate the 1-year outcomes of patients undergoing CSP versus conventional PM after TAVI.
Methods
In this prospective, observational, multicentric cohort study, the outcomes of patients undergoing permanent PM implantation were investigated. Patients were enrolled from three centers across Switzerland between February 2011 and June 2022.
Results
Among 778 patients receiving PM implantation within 30 days after TAVI (mean age 83±7 years, 40% female, self-expanding valves 54%), 85 (11%) underwent CSP. Patients that received CSP had lower prevalence of coronary artery disease (36, 42% vs. 377, 54%, p = 0.04), received more often balloon-valvuloplasty (36, 42% vs 376, 54%, p=0.04). At one year after PM implant, a composite of all-cause death, a LVEF decline ≥ 10%, and worsening of NYHA class III/IV occurred less often in CSP (HR 0.61, 95% CI 0.43-0.88, p = 0.007) but was not significant after adjusting for age, sex, year of TAVI implant as well as several baseline and procedural parameters (aHR 0.72, 95% CI 0.49- 1.05, p = 0.09). A LVEF decline ≥10% occurred numerically less often, yet not statistically different in CSP compared to right ventricular pacing (3, 8% vs. 78, 18%, HR 0.45, 95% CI 0.15-1.35, p=0.16).
Conclusions
In this prospective multicentric study, patients receiving CSP within 30 days after TAVI had a lower occurrence of a combined endpoint of death, LVEF decline of ≥ 10% or a worsening in NYHA class III/IV at one year compared to conventional right ventricular pacing but not significantly after multivariable adjustment. The findings are subject to potential time-related confounding despite multivariable adjustment.Graphical Abstract