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. 2021 Feb 12:6:41-55.e15.
doi: 10.1016/j.xjon.2021.02.002. eCollection 2021 Jun.

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

Justine M Ravaux  1 , Michele Di Mauro  1 , Kevin Vernooy  2   3   4 , Arnoud W Van't Hof  2   3 , Leo Veenstra  2 , Suzanne Kats  1 , Jos G Maessen  1   3 , Roberto Lorusso  1   3
Affiliations

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

Justine M Ravaux et al. JTCVS Open. .

Abstract

Objectives: Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI.

Methods: We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted.

Results: Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI.

Conclusions: Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term.

Keywords: AF, atrial fibrillation; BE, balloon-expandable; CI, confidence interval; OR, odds ratio; PPI, permanent pacemaker implantation; RBBB, right bundle branch block; SE, self-expandable; STS, Society of Thoracic Surgeons; TAVI, transcatheter aortic valve implantation; conduction disturbances; pacemaker dependency; permanent pacemaker; transcatheter aortic valve implantation.

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Figures

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Graphical abstract
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Rate of pacemaker dependency across the time after TAVI.
Figure 1
Figure 1
Study selection. Flow diagram of included studies based on the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA).
Figure 2
Figure 2
Pacemaker dependency at 1 year. Bars represent 1-year pacemaker dependency. The rate of pacemaker dependency ranged from 7% to 89% in individual studies.
Figure 3
Figure 3
Rate of pacemaker dependency across the time after TAVI. Pooled percentage is reported with 95% confidence limits (blue line). Light blue bars represent number of studies. Yellow line is the interpolation line. UCL, Upper confidence limit; LCL, lower confidence limit.
Figure 4
Figure 4
Impact of baseline RBBB on 1-year rate of pacemaker dependency Forest plot. Patients with baseline RBBB have 2-fold greater risk to develop pacemaker dependency 1 year after TAVI. TE, Log odds ratio; SE, standard error; IV, weighted mean difference; CI, confidence limits; PM, pacemaker.
Figure 5
Figure 5
Impact of baseline AF on 1-year rate of pacemaker dependency. Forest plot. Patients with baseline AF have no greater risk to develop pacemaker dependency 1 year after TAVI. TE, Log odds ratio; SE, standard error; IV, weighted mean difference; CI, confidence limits; PM, pacemaker.
Figure 6
Figure 6
Impact of SE prosthesis (vs BE) on 1-year rate of pacemaker dependency. Forest plot. Patients with SE prosthesis have 2-fold greater risk to develop pacemaker dependency at 1 year after TAVI. TE, Log odds ratio; SE, standard error; IV, weighted mean difference; CI, confidence limits; PM, pacemaker.
Figure 7
Figure 7
Up to 50% of the patients with permanent pacemaker implantation following TAVI exhibits no pacemaker dependency at 1-year follow-up. TAVI, Transcatheter aortic valve implantation; PPI, permanent pacemaker implantation; RBBB, right bundle branch block; TE, log odds ratio; SE, standard error; IV, weighted mean difference; CI, confidence limits; PM, pacemaker.
Figure E1
Figure E1
Funnel plot on the impact of baseline RBBB on 1-year rate of pacemaker dependency. No publication bias was found among studies reporting the influence of baseline RBBB on pacemaker dependency.
Figure E2
Figure E2
Funnel plot on the influence of baseline AF on pacemaker dependency. No publication bias was found among studies reporting the influence of baseline AF on pacemaker dependency.
Figure E3
Figure E3
Funnel plot on the influence of SE versus BE valves on pacemaker dependency. No publication bias was found among studies reporting the influence of SE versus BE on pacemaker dependency.
Figure E4
Figure E4
Forest plot pooling pacemaker dependency according to percentage of SE prosthesis included in the study. IV, Weighted mean difference; CI, confidence interval; SE, self-expandable.
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References

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References of low-sample studies including <250 patients

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