TY - JOUR
T1 - Permanent pacemaker implantation after transcatheter aortic valve implantation impact on late clinical outcomes and left ventricular function
AU - Urena, Marina
AU - Webb, John G.
AU - Tamburino, Corrado
AU - Muñoz-García, Antonio J.
AU - Cheema, Asim
AU - Dager, Antonio E.
AU - Serra, Vicenç
AU - Amat-Santos, Ignacio J.
AU - Barbanti, Marco
AU - Immè, Sebastiano
AU - Briales, Juan H.Alonso
AU - Benitez, Luis Miguel
AU - Al Lawati, Hatim
AU - Cucalon, Angela Maria
AU - Del Blanco, Bruno García
AU - López, Javier
AU - Dumont, Eric
AU - DeLarochellière, Robert
AU - Ribeiro, Henrique B.
AU - Nombela-Franco, Luis
AU - Philippon, François
AU - Rodés-Cabau, Josep
PY - 2014
Y1 - 2014
N2 - Background: Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. Methods and Results: A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74-1.30; P=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56-1.17; P=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77-1.30; P=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11-0.85; P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (P=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6-to 12-month follow-up (estimated coefficient, -2.26; 95% confidence interval, -4.07 to -0.44; P=0.013; R 2=0.121). Conclusions: The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
AB - Background: Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. Methods and Results: A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74-1.30; P=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56-1.17; P=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77-1.30; P=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11-0.85; P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (P=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6-to 12-month follow-up (estimated coefficient, -2.26; 95% confidence interval, -4.07 to -0.44; P=0.013; R 2=0.121). Conclusions: The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
KW - Aortic stenosis
KW - Aortic valve
KW - Artificial
KW - Cardiac
KW - Death
KW - Heart valves
KW - Pacemaker
KW - Sudden
UR - http://www.scopus.com/inward/record.url?scp=84897563542&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84897563542&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.113.005479
DO - 10.1161/CIRCULATIONAHA.113.005479
M3 - Article
C2 - 24370552
AN - SCOPUS:84897563542
SN - 0009-7322
VL - 129
SP - 1233
EP - 1243
JO - Circulation
JF - Circulation
IS - 11
ER -