Abstract 14362: Shifting Trends in Timing of Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Abstract

Introduction: Hospital length of stay with transcatheter aortic valve replacements (TAVRs) has decreased, though the rate of heart block requiring permanent pacemaker (PPM) implantation after TAVR has remained steady. It is unknown whether more patients are being readmitted for PPM after discharge from TAVR. Objective: To explore frequency, timing, and risk factors for PPM implant after TAVR in a nationally representative database. Methods: Patients who underwent TAVR from January 2012 through December 2017 were identified in the Nationwide Readmissions Database (NRD). Smoothing splines and logistic regression were used to analyze trends in length of stay and timing of PPM implantation after TAVR respectively. Multivariable logistic regression analysis was performed to identify risk factors for overall, early (during index hospitalization), and late (during subsequent hospitalization) PPM after TAVR. Results: Of the 62,083 included, 6,817 (11.0%) underwent PPM implantation [6,137 (9.9%) early and 680 (1.1%) late]. Rates of PPM remained stable between 8% and 12.5% with an increasing proportion occurring late (7% in 2012 increasing to 13% in 2017, p < 0.0001 for trend) (Figure 1). Late PPM was associated with atrial fibrillation (p < 0.01), diabetes mellitus (p < 0.001), chronic kidney disease (p < 0.05), second degree AVB (p < 0.001), left bundle branch block (p < 0.001), right bundle branch block (p < 0.001), and bifascicular block (p < 0.001). Conclusions: There has been a significant increase in the proportion of patients requiring readmission for PPM implantation after TAVR. As this high-risk population grows, algorithms for extended in-hospital observation or ambulatory cardiac monitoring post-TAVR are needed to reduce the risk for adverse events.