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Predictive Factors for Permanent Pacemaker Implantation and Mortality after Transcatheter Aortic Valve Replacement in Patients with Pre-Existing Atrial Fibrillation

Year: 2025

Type: article

Abstract: INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia among patients undergoing transcatheter aortic valve replacement (TAVR). Post-TAVR permanent pacemaker implantation (PPI) predictors for patients in sinus rhythm were studied. However, scarce data are available about patients with AF. The aim of the study was to assess the prevalence of AF among patient undergoing TAVR, to identify predictors of PPI, and to study the association between PPI and long-term mortality. METHODS: A historical cohort study of all patients who underwent TAVR between 2008 and 2022 in a large tertiary medical center was conducted. Patients with prior aortic valve bioprosthesis or pacemakers were excluded. Thirty-day PPI and 3-year mortality were studied. Univariate and multivariable analyses were performed. RESULTS: Of the 1,579 patients who met the inclusion criteria, 405 (25.6%) had a history of AF either paroxysmal (17.1%) or persistent (8.4%). Among them, 49.9% were male and the mean age was 82 ± 6 years. The 30-day PPI rate was 21.7%. Right bundle branch block (RBBB, aOR 5.34, 95% CI: 2.79-10.21) and CoreValve/Evolut valve (aOR 2.51, 95% CI: 1.40-4.51) were significantly associated with 30-day PPI. PPI was not statistically significant associated with increased 3-year mortality. CONCLUSION: AF is prevalent among TAVR patients and PPI rates among this population are high. Predictors for PPI among patients with AF are similar to prior known predictors in patients with sinus rhythm and include baseline RBBB and transcatheter heart valve type. Despite the high PPI rates, there is no association between PPI and long-term mortality among patients with AF.

Source: Cardiology

DOI: 10.1159/000549304