One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysisCentral MessagePerspective
Justine M. Ravaux, MD,
Michele Di Mauro, MD, PhD, MSc Biostat,
Kevin Vernooy, MD, PhD,
Arnoud W. Van't Hof, MD, PhD,
Leo Veenstra, MD,
Suzanne Kats, MD, PhD,
Jos G. Maessen, MD, PhD,
Roberto Lorusso, MD, PhD
Affiliations
Justine M. Ravaux, MD
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Address for reprints: Justine M. Ravaux, MD, Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.
Michele Di Mauro, MD, PhD, MSc Biostat
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Kevin Vernooy, MD, PhD
Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
Arnoud W. Van't Hof, MD, PhD
Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Leo Veenstra, MD
Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Suzanne Kats, MD, PhD
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Jos G. Maessen, MD, PhD
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
Roberto Lorusso, MD, PhD
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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.
