Prevalence of high ventricular pacing burden in patients requiring permanent pacemaker post TAVR.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is occasionally complicated by high degree atrioventricular block (AVB) requiring permanent pacemaker (PPM) placement. Newer valve design, delivery platform evolution, and deployment technique refinement have lowered this risk. Ventricular pacing ≥ 30% has been previously identified as a predictor for worse clinical outcomes in this population. This study aims to assess the prevalence of high long-term pacing burden in this cohort.

Methods: This is a retrospective study to evaluate patients from 2019 to 2023 who required PPM for high degree AVB following TAVR. Baseline demographics, clinical characteristics, procedural details were obtained. Ventricular pacing (VP) percentages were collected from PPM interrogations at 1, 6 and 12 months.

Results: 138 patients had PPM placement post-TAVR. Approximately one third of patients demonstrated ventricular pacing less than 25% at 1 month, 6 months, and 12 months (Fig. 1). Roughly 50% of patients had > 75% ventricular pacing at 1 month, 6months and 12 months. There was no difference in baseline demographics or EKG characteristics at 1 month. In a univariable logistic regression analysis, there were no statistically significant predictors of VP ≥ 30%. Although, balloon expandable valves and lower STS scores demonstrated an association with lower risk of VP ≥ 30%.

Conclusions: Our study suggests that a significant portion of patients with PPM for high degree AVB after TAVR have low pacing burden at 6-12 months. Further investigation is needed to assess valve-specific predictors and alternative pacing approaches of AVB management.