Pacing-Related Differences After SAPIEN-3 TAVI: Clinical and Echocardiographic Correlates

Abstract

Data regarding the impact of pacing on outcomes after transcatheter aortic valve implantation (TAVI) is evolving especially with regards to pre-existing permanent pacemaker (PPM). We examined the impact of new and previous PPM on the clinical and hemodynamic outcomes after SAPIEN-3 TAVI. We included all consecutive patients who underwent transfemoral TAVI using SAPIEN-3 valve from 2015 to 2018 at our institution. Among 1,028 patients, 10.2% required a new PPM within 30days, whereas 14% had a pre-existing PPM. The presence of either previous or new PPM had no impact on the 3-year mortality (log-rank p=0.6) or 1-year major adverse cardiac and cerebrovascular events (log-rank p=0.65). New PPM was associated with lower left ventricular (LV) ejection fraction (LVEF) at both 30days (54.4 ± 11.3% vs 58.4 ± 10.1%, p=0.001) and 1year (54.2 ± 12% vs 59.1 ± 9.9%, p=0.009) than no PPM. Similarly, previous PPM was associated with worse LVEF at 30days (53.6 ± 12.3%, p <0.001) and 1year (55.5 ± 12.1%, p=0.006) than no PPM. Interestingly, new PPM was associated with lower 1-year mean gradient (11.4 ± 3.8 vs 12.6 ± 5.6mm Hg, p=0.04) and peak gradient (21.3 ± 6.5 vs 24.1 ± 10.4mm Hg, p=0.01), despite no baseline differences. Previous PPM was also associated with lower 1-year mean gradient (10.3 ± 4.4mm Hg, p=0.001) and peak gradient (19.4 ± 8mm Hg, p <0.001) and higher Doppler velocity index (0.51 ± 0.12 vs 0.47 ± 0.13, p=0.039). Moreover, 1-year LV end-systolic volume index was higher with new (23.2 ± 16.1 vs 20 ± 10.8ml/m2, p=0.038) and previous PPM (24.5 ± 19.7, p=0.038) than no PPM. Previous PPM was associated with higher moderate-to-severe tricuspid regurgitation (35.3% vs 17.7%, p <0.001). There were no differences regarding the rest of the studied echocardiographic outcomes at 1year. In conclusion, new and previous PPM did not affect 3-year mortality or 1-year major adverse cardiac and cerebrovascular events; however, they were associated with worse LVEF, higher 1-year LV end-systolic volume index, and lower mean and peak gradients on follow-up than no PPM.