Impact of TAVR on pacemaker dependency in patients with pre-existing devices: predictors and one-year outcomes
O Ayyad, H Abu Khadija, A Mahamid, M Masu'd, O Hamdan, N Abu Hamdeh, R Saed, D Najajra, W Awad, Y Fraitekh, A Darwish, K Ibraheem, M AlneesAbstract
Background
Pacemaker dependency and the impact of ventricular pacing burden after Transcatheter Aortic Valve Replacement (TAVR) in patients with pre-existing pacemakers remain poorly defined.
Objectives
To assess changes in pacemaker dependency after TAVR, identify predictors of 1-month dependency, and evaluate whether Ventricular Pacing (VP) % ≥40% predicts 1-year clinical outcomes.
Methods
We performed a retrospective cohort study of consecutive patients with symptomatic severe aortic stenosis and a preexisting permanent pacemaker who underwent TAVR at a single center between 2010 and 2024. Pacemaker interrogation was performed before TAVR, at 1 month, and at 6–12 months. Pacemaker dependency was defined as ventricular pacing percentage (VP%) >80% with a programmed lower rate of 60 bpm in VVI or DDD mode. Predictors of 1-month dependency were assessed using Firth penalized logistic regression. For 1year outcomes (stroke, heart failure hospitalization, allcause mortality, and newonset atrial fibrillation), patients were stratified by VP% ≥40% at 1 month, and timetoevent analyses were performed using Royston–Parmar flexible parametric models or Cox regression.
Results
Among 102 patients analyzed, 53% were pacemakerdependent before TAVR, increasing to 75% at 1 month and 69% at 6–12 months. In multivariable analysis, preprocedural QRS duration was the only strong independent predictor of 1month dependency (odds ratio [OR] 1.07 per 1ms increase; 95% CI 1.02–1.11; p=0.001), whereas baseline dependency, QTc interval, and annulus perimeter were not significant. A ventricular pacing burden ≥40% at 1 month was not significantly associated with 1year stroke, heart failure hospitalization, or allcause mortality. There was a association with newonset atrial fibrillation (adjusted hazard ratio 7.29; 95% CI 1.98–9.16; p=0.043).
Conclusions
Pacemaker dependency is common and increases after TAVR. Baseline QRS duration predicts 1-month dependency. VP% ≥40% at 1 month was not associated with 1-year mortality, stroke, or heart failure hospitalization but may relate to higher atrial fibrillation risk.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.