The Incidence, Predictors, and Mortality Impact of Ventricular Pacing Dependency after Transcatheter Aortic Valve Replacement: A Prospective Cohort

BackgroundAtrioventricular conduction disturbance occurs in a significant number of patients underwent transcatheter aortic valve replacement (TAVR). However, not all of the cases persistently depend on ventricular pacing. ObjectiveTo study the incidence, predictors, and outcomes of new ventricular pacing dependency (VpDep) after TAVR. DesignProspective, single-center, cohort trial MethodsThe first 130 consecutive transfemoral TAVR cases, except 3 with prior cardiac electronic implantable devices (CIEDs) who depended on ventricular pacing, were analyzed. The endpoints were VpDep at 1 month and all-cause mortality at the end of follow-up in 2021. The effects of variables on VpDep and all-cause mortality were evaluated using multivariate binary logistic regression and Cox-regression analysis, respectively. First degree atrioventricular block (AVB) was considered severe when PR interval > 300 ms. ResultsOut of 127 patients in the analysis (mean age 82 years, SD 6.3; 62.2% female sex; 67.7% Balloon-expandable device), 7 patients (5.5%) had implanted with CIEDs before TAVR but not ventricular pacing dependent. The incidence of VpDep at 1 month was 7.9% (n=10) among all patients and 34.5% among patients with CIEDs (n=29). VpDep was likely to occur in patients with pre-existing right bundle branch block (OR 21.38; 95% CI 3.25-139.33; P=.001) and severe 1st degree or Mobitz I AVB (OR 14.79; 95% CI 1.65-132.74; P=.016). After a mean follow-up of 25.8 months (SD 21.2), death from any causes occurred in 18 patients (14.2%). VpDep was not associated with excess mortality. ConclusionVpDep at 1 month occurred in 7.9% of all patients underwent TAVR. Pre-existing conduction abnormalities were significantly associated with higher risk of VpDep. Mortality was similar between patients with and without VpDep. Clinical Trial RegistrationThai Clinical Trial Registration; Study ID: TCTR20220726005