Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: The PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration) Pacemaker substudy

Gennaro Giustino, Robert M A Van Der Boon, Javier Molina Martin De Nicolas, Nicolas Dumonteil, Alaide Chieffo, Peter P T De Jaegere, Didier Tchetche, Bertrand Marcheix, Damien Millischer, Romain Cassagneau, Didier Carrié, Nicolas M. Van Mieghem, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Aims: We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality and one-year left ventricular ejection fraction recovery (δLVEFR=one-year LVEF-baseline LVEF) after transcatheter aortic valve implantation (TAVI). Methods and results: We pooled patient-level data from four European institutions with significant TAVI volume. Outcomes were compared between patients without PPM (no-PPM), patients with PPM prior to TAVI (old-PPM) and patients with PPM implanted after TAVI (new-PPM). Out of 1,062 patients included in the pooled data set, 783 (73.7%) were in the no-PPM group, 164 (15.4%) in the new-PPM group and 115 (10.8%) in the old-PPM group. All-cause and cardiovascular mortality at two years were similar for patients with no-PPM and new-PPM (adjusted HR 1.11, 95% CI: 0.74-1.67; p=0.62; and adjusted HR 1.16, 95% CI: 0.68-1.98; p=0.59). Conversely, old-PPM was associated with increased risk of both all-cause and cardiovascular mortality vs. no-PPM. By multivariable analysis new-PPM did not affect LVEFR, while oldPPM did. We observed a multiplicative interaction, between new-PPM and post-procedural aortic regurgitation =1+ on two-year mortality and one-year LVEFR, with increased risk of death and impaired LVEFR in patients with new-PPM and post-procedural aortic regurgitation (PPAR) ≥1+ (both pinteraction<0.0001). Conclusions: In patients undergoing TAVI, the presence of a PPM at baseline yielded a negative effect on long-term prognosis while new-PPM did not. The combination of new-PPM with PPAR adversely impacts on survival and LV function recovery.

Original languageEnglish
Pages (from-to)1185-1193
Number of pages9
JournalEuroIntervention
Volume12
Issue number9
DOIs
Publication statusPublished - Oct 1 2016

Keywords

  • Left ventricular ejection fraction
  • Mortality
  • Pacemaker
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Giustino, G., Van Der Boon, R. M. A., De Nicolas, J. M. M., Dumonteil, N., Chieffo, A., De Jaegere, P. P. T., Tchetche, D., Marcheix, B., Millischer, D., Cassagneau, R., Carrié, D., Van Mieghem, N. M., & Colombo, A. (2016). Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: The PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration) Pacemaker substudy. EuroIntervention, 12(9), 1185-1193. https://doi.org/10.4244/EIJV12I9A192