Abstract 4367519: Frequency and mid-term outcomes of permanent pacemaker implantation pre- and post-transcatheter aortic valve implantation: A single-center experience in Japan using new-generation valves

Introduction: Atrioventricular block is a known complication of transcatheter aortic valve implantation (TAVI). However, the prognostic effect of permanent pacemaker implantation (PPI) pre- and post-TAVI remains unclear. Research Question/Hypothesis: We retrospectively examined the association between pre- and post-TAVI PPI and mortality. Methods: We analyzed 500 Japanese patients who underwent TAVI at our institution between June 2017 and October 2022. This single-center design ensured a high degree of data uniformity. Among the participants, 166 were men (mean age: 85.2 ± 4.6 years), and 457 and 43 received the new-generation Sapien 3 and Evolut Pro+ valves, respectively. Of the 500 patients, eight died within 30 d, including one each from the pre- and post-TAVI PPI groups. After excluding these cases, the final analysis included 492 patients: 27, 17, and 448 in the pre-TAVI PPI, post-TAVI PPI, and non-PPI groups, respectively. A multivariable Cox proportional hazards model was used to identify independent mortality predictors, adjusting for post-TAVI PPI, age ≥ 90 years, sex, MMSE ≤ 23, and Clinical Frailty Scale ≥ 5. Results: The overall post-TAVI PPI rate was 3.8% (18/472), with 7 and 11 transvenous and leadless pacemakers, respectively. During a median follow-up of 930 d (IQR: 614.5–1304.5, range: 28–2358 d), we recorded 79 deaths, resulting in 35.3% and 16.3% of mortality in the post-TAVI PPI and non-PPI groups, respectively. Although this difference was not statistically significant (p = 0.051), we observed a trend toward increased mortality rates. Kaplan-Meier analysis demonstrated significantly lower survival in the post-TAVI PPI than that in the non-PPI group (p = 0.023). Multivariable Cox proportional hazards analysis confirmed post-TAVI PPI as an independent predictor of mortality (HR: 2.61, 95% CI: 1.11–6.13, p = 0.028). Survival analysis between the pre-TAVI PPI and non-PPI groups revealed no significant difference (p = 0.129). Conclusion: The post-TAVI PPI rate at our institution was comparable to that reported in previous studies (2.1–16.9%). This single-center Japanese study using new-generation TAVI valves suggested that post-TAVI PPI is associated with increased mortality, highlighting the importance of minimizing PPI after TAVI to improve outcomes. However, few studies have directly compared survival differences between patients with pre-existing pacemakers and those requiring new implantation post-TAVI. Hence, further studies are warranted.