Long-Term Outcomes of Patients Requiring Pacemaker Implantation After Transcatheter Aortic Valve Replacement: The SwissTAVI Registry
- PMID: 40368460
- DOI: 10.1016/j.jcin.2025.03.028
Long-Term Outcomes of Patients Requiring Pacemaker Implantation After Transcatheter Aortic Valve Replacement: The SwissTAVI Registry
Abstract
Background: The impact of pacemaker (PM) implantation on outcomes following transcatheter aortic valve replacement (TAVR) remains controversial, especially as TAVR indications expand to low-risk patients.
Objectives: This study sought to evaluate the all-cause and cardiovascular mortality of patients undergoing PM implantation after TAVR.
Methods: In this prospective, observational, nationwide TAVR cohort study, the outcomes of patients undergoing permanent PM implantation were investigated. Patients were enrolled from 19 centers across Switzerland between February 2011 and June 2022.
Results: Among 13,360 patients enrolled (mean age 82 ± 7 years, 47% female, self-expanding valves 48%, median follow-up 889 days [Q1-Q3: 365-1,765 days]), 2,028 (15%) required PM implantation within 30 days post-TAVR. Patients requiring post-TAVR PM implantation were older (82 ± 6 years of age vs 81 ± 7 years of age), were predominantly male (58% vs 50%), and more often had atrial fibrillation (34% vs 29%). At 1-year follow-up, these patients had higher overall mortality (aHR: 1.15; 95% CI: 1.05-1.26; P = 0.002) and cardiovascular mortality (aHR: 1.25; 95% CI: 1.06-1.46; P = 0.006). These trends persisted at 5- and 10-year follow-up. After multivariable adjustments, significantly higher rates of cardiovascular mortality, LVEF decline ≥10%, and NYHA functional class III or IV at 1-year follow-up were observed (aHR: 1.44,; 95% CI: 1.35-1.54; P < 0.001), along with higher all-cause and cardiovascular mortality rates at 5- and 10-year follow-up in patients requiring PM implantation following TAVR compared with those not needing a PM.
Conclusions: In this large nationwide registry, patients receiving PM implantation within 30 days after TAVR had significantly higher rates of overall and cardiovascular mortality up to 10 years. (SwissTAVI Registry; NCT01368250).
Keywords: cardiovascular mortality; heart failure; high-degree atrioventricular block; pacemaker implantation; transcatheter aortic valve replacement.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Badertscher has received research funding from the University of Basel, the Stiftung für Herzschrittmacher und Elektrophysiologie, the Freiwillige Akademische Gesellschaft Basel, the Swiss Heart Foundation, and Johnson & Johnson, all outside the submitted work; and personal fees from Abbott, Boston Scientific, and BMS Pfizer. Dr Serban has received research funding from the Swiss Academy of Medical Sciences and the Gottfried & Julia Bangerter-Rhyner Foundation. Dr Jeger has received grants to his Institution from Abbott, Amgen, AstraZeneca, Bayer, Biosense Webster, B. Braun Melsungen AG, Biotronik, Boston Scientific, Bristol Myers Squibb, Cardionovum, Cordis, Daiichi-Sankyo, Edwards Lifesciences, GE Medical Systems, MCM Medsys, Medtronic, Novartis, Pfizer, Terumo, and Vascular Medical GmbH, all outside the submitted work. Dr Toggweiler has received honoraria from Medtronic, Boston Scientific, Biosensors, Hi-D Imaging, Abbott Vascular, Medira, Shockwave, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, and Daiichi-Sankyo; has received institutional research grants from Edwards Lifesciences, Abbott Vascular, Boston Scientific, Fumedica, Novartis, Boehringer Ingelheim, and Polares Medical; and holds equity in Hi-D Imaging. Dr Roffi has received institutional research grants from Biotronik, Terumo, Boston Scientific, and Cordis. Dr Mahfoud has received research grants from Deutsche Gesellschaft für Kardiologie, Deutsche Forschungsgemeinschaft (SFB TRR219, Project-ID 322900939), and Deutsche Herzstiftung; his employer (Saarland University) has received scientific support from Ablative Solutions, Medtronic, and ReCor Medical; and he has received speaker honoraria/consulting fees from Ablative Solutions, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor Medical, Servier, and Terumo (all until May 2024). Dr Sticherling has served on the Medtronic Advisory Board Europe and Boston Scientific Advisory Board Europe; received educational grants from Biosense Webster and Biotronik; received a research grant from the European Union’s FP7 program and Biosense Webster; and received lecture and consulting fees from Abbott, Medtronic, Biosense Webster, Boston Scientific, MicroPort, and Biotronik, all outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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