Dependence on permanent pacemakers inserted after transcatheter aortic valve implantation: predictive factors in a ten-year retrospective analysis: Rates and predictors of pacemaker dependence after TAVI.

AIMS: The requirement for a permanent pacemaker (PPM) is an important sequela after transcatheter aortic valve implantation (TAVI). The aim of this analysis was to identify predictive factors for pacemaker dependence in PPM-insertions post-TAVI. METHODS AND
RESULTS: A retrospective analysis of all PPM insertions done between January 2009 and December 2018 (n=1,373) identified 33 patients who received a PPM within one month of TAVI. Thirty-two had completed a PPM check at one year and were included in the final analyses. Of those who had PPM insertions after TAVI, 41% (13/32) were not PPM-dependent at one year. This cohort was predominantly European (94%) and over half were octogenerians (56%). Statistically significant associations with being PPM-dependent at one year include intraoperative PPM dependence (OR 5.714 [95% CI: 1.163-28.070]; p=0.032), third-degree heart block being the indication for PPM insertion (OR 8.533 [95% CI: 1.616-45.063]; p=0.012) and mean valve depth over 6.0 mm (OR 6.222 [95% CI: 1.200-32.273]; p=0.030).
CONCLUSIONS: A significant number of patients are not dependent on the PPMs inserted after TAVI. Although small, our study suggests that those who are pacing-dependent intraoperatively, have a third-degree heart block as their PPM indication or have a mean valve depth of over 6.0 mm, are more likely to be pacing-dependent in the long term. Larger studies are required to draw more definitive conclusions.