Open Access

Long-term clinical impact of permanent cardiac pacing after transcatheter aortic valve implantation with the CoreValve prosthesis: a single center experience

logo

Date: 4 May 2017
Journal: EP Europace Journal , Volume 20 , Issue 6 , Pages 993 - 1000
Authors: J. López-Aguilera , J. Segura Saint-Gerons , J. Sánchez Fernández , F. Mazuelos Bellido , M. Pan Álvarez-Ossorio , J. Suárez de Lezo , M. Romero Moreno , S. Ojeda Pineda , D. Pavlovic , D. Mesa Rubio , S. Rodriguez Diego , C. Ferreiro , E. Durán , J. Chavarría , J. Moya González , J. Suárez de Lezo

ESC Journals

AbstractAims

To determine the impact of permanent cardiac pacing after transcatheter aortic valve implantation (TAVI) with the CoreValveTM prosthesis in terms of all-cause mortality and morbidity [rehospitalizations for heart failure (HF) or stroke] at the long-term follow-up.

Methods and results

The prospective analysis comprised 259 patients (138 women, 53.3%, age 78 ± 6 years) treated by a CoreValveTM prosthesis from April 2008 to December 2015. Forty-two patients were excluded for analysis: 9 with pre-existing permanent pacemaker (PPM) implantation, 19 who required a PPM during the follow-up and 14 patients because of hospital mortality during or after the CoreValveTM prosthesis implantation procedure. The remaining 217 patients were divided in two groups: Group-1 included those patients who required a PPM immediately after TAVI, and Group-2 included those patients who did not require permanent cardiac pacing at the long-term follow-up. Patients received follow-up at 1-month, 6-months, 12-months, and yearly thereafter. A total of 39 patients required a PPM immediately after TAVI (15.0%), but 178 patients (68.7%) did not. The mean follow-up was 37 ± 27 months (range 3–99 months) in both groups. There was no difference between the two groups in terms of all-cause mortality (52.6% vs. 56.8%, P = 0.125; HR 1.22 [0.87–1.77, 95% CI]), or stroke (13.3% vs. 15.1% P = 0.842; HR 1.12 [0.37–3.32, 95% CI]). However, patients who underwent PPM implantation developed an increase in readmissions for HF (21.1% vs. 31.9%, P = 0.015; HR 1.82 [1.23–3.92, 95% CI]).

Conclusion

Patients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up.

About the contributors

J López-Aguilera

Cordoba (University Hospital Queen Sofia)

Role: Author

J M Segura Saint-Gerons

Role: Author

J Sánchez Fernández

Role: Author