Pacemaker implantation following TAVI: influence of prosthesis type on incidence and timing
T Carlos, L Rocha, M Grine, B Resende, D Fernandes, J Guimaraes, G Batista, T Santos, A Silva, M Simoes, L Leite, M Costa, L GoncalvesAbstract
Introduction
Transcatheter aortic valve implantation (TAVI) offers significant clinical benefits but is also associated with certain adverse events, particularly the need for pacemaker implantation (PI). Risk factors for PI include pre-existing conduction abnormalities and calcium distribution.
Purpose
Evaluate the impact of different TAVI prosthesis on the incidence and timing of PI within 30 days post-procedure.
Methods
We performed a single-centre retrospective study of 628 patients who underwent TAVI between March 2020 and September 2023. Patients were divided into five groups based on the prosthesis type, and baseline characteristics were compared. The primary outcomes were the 30-day PI rate and the time to its implantation. Statistical analysis included non-parametric tests, Kaplan-Meier survival analysis, and Cox regression.
Results
Five types of TAVI prostheses were used, with the Evolut® valve being the most frequently represented (44.1%). Baseline characteristics included pre-TAVI conduction disturbances, particularly a higher prevalence of right bundle branch block (RBBB) in the Sapien 3 Ultra® cohort (21.4%). Additionally, the aortic valve calcium score was significantly elevated in both the Sapien 3 Ultra® and Evolut® cohorts (p=0.001). Among the 118 patients (18.8%) who required permanent PI, the incidence varied significantly across valve types (p=0.006). The Navitor® (29.4%) and Sapien 3 Ultra® (23.3%) valves demonstrated the highest PI rates. While the median time to PI did not differ significantly between valve types (p=0.079), the Navitor® valve showed a trend toward delayed PI (median 3.5 days, IQR 5.0). Kaplan-Meier analysis indicated significant differences in 30-day PI-free survival among valve types (log-rank test, p=0.001), with the Portico® valve achieving the highest rate (96.0%). The Navitor® valve exhibited a gradual decline in pacemaker-free survival over time compared to other valves. After adjusting for confounding factors and using the Portico® valve as reference, Cox regression analysis suggested that the Navitor® valve was associated with a significantly higher risk of PI (HR 10.66, CI 1.45-78.40, p=0.020).
Conclusion
The Sapien 3 Ultra® and Navitor® valves were associated with elevated rates of permanent PI. For the Sapien 3 Ultra®, this was largely driven by a higher aortic valve calcium score and the presence of pre-existing conduction disturbances. In contrast, the increased PI risk with the Navitor® valve seemed to stem mainly from its inherent characteristics, which led to a greater occurrence of new-onset rhythm disturbances following TAVI. Furthermore, the Navitor® valve demonstrated a tendency for delayed PI and a more gradual decline in pacemaker-free survival over time compared to other valves.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.