Impact of transcatheter aortic valve implantations on temporal trend in pacemaker implantations over the last decade using the French National Healthcare database

Abstract

Transcatheter aortic valve implantation (TAVI) has emerged in 2010's for high-risk patients. Permanent pacemaker implantation (PPMI) is a common complication after TAVI procedure. There are no data on the eventual impact of TAVI on PPMI temporal trends, at a nationwide scale. First, to evaluate whether PPMI have increased in France during the period 2008–2018, and secondly to evaluate the extent to which those post-TAVI PPMI could explain such potential increase. We used the Échantillon Généraliste de Bénéficiaires (EGB), the 1/97th randomly selected sample of the French healthcare database to identify patients with PPMI and TAVI performed between 2008 and 2018. The number of observed PPMI, O, in the period 2013–2018 (TAVI period) was compared with the expected number of PPMI, E, calculated by using 2008–2012 (pre-TAVI period) incidence rates. We computed the standardized incidence ratio (SIR) of the observed number of PPMI to the expected number of PPMI (O/E), with 95% confidence intervals (CIs). We evaluated the contribution of post-TAVI PPMI in the overall number of excess cases of PPMI (O-E) for the period 2013–2018. The EGB included more than 500,000 individuals each year with an increasing part of octogenarians (> 80 years) (4.7% in 2008; 5.9% in 2018). By removing the effect of age, the PPMI annual rate remained stable, except for octogenarians: 546 in 2008 to 676 per 100,000 inhabitants in 2018, especially after 2012 with a significant SIR = 1.06 (95% CI: 1.01–1.12). In this group of octogenarians, 72% of the increase appeared to be related to post-TAVI PPMI. Between 2008 and 2018 in France, the incidence of PPMI significantly increased only among octogenarians. Post-TAVI PPMI could explain more than 70% of this increase.