Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self‐Expanding Prosthesis

BACKGROUND: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR. AIMS: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis. METHODS: Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up. RESULTS: Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001). CONCLUSIONS: PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.

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Journal
Catheterization and Cardiovascular Interventions
Published
2026-05-12
DOI
https://doi.org/10.1002/ccd.70652
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self‐Expanding Prosthesis

Erica Ferrara, Bruno Merlanti, Luca Paolucci, C Giannini et al.
Catheterization and Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self‐Expanding Prosthesis

Erica Ferrara, Bruno Merlanti, Luca Paolucci, C Giannini, Tiziana Attisano, Domenico Gabrielli, Antonio Sisinni, Mauro Pennacchi, Carmine Musto, Marco Stefano Nazzaro, Arnaldo Poli, Diana Chin, M Adamo, B Bellini, D Regazzoli, Giulia Costa, Francesco De Felice, Giuseppe Bruschi, Mauro Massussi, Marco De Carlo, Luca Testa, Rocco Stio, Matteo Montorfano, Giuliano Chizzolla, Tullio Palmerini
article en

Abstract

BACKGROUND: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR. AIMS: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis. METHODS: Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up. RESULTS: Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001). CONCLUSIONS: PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.

Catheterization and Cardiovascular Interventions
Vita-Salute San Raffaele University (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), IRCCS Policlinico San Donato (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Azienda USL di Bologna (IT), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Ospedale Civile di Legnano (IT), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Universitaria Pisana (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Brescia (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 6%
Cardiac Valve Diseases and Treatments
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