PO-03-111 PACEMAKER DEPENDENCY AND IMPACT ON MORTALITY FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT

Abstract

Conduction abnormalities requiring permanent pacemaker (PPM) are a frequent complication following TAVR. Few studies have evaluated chronic pacemaker dependency after TAVR. To evaluate post-TAVR pacemaker dependency and impact on mortality at one year. 626 patients with severe aortic stenosis who underwent TAVR between 01/01/2012 and 12/31/2019 were identified. Those with pre-TAVR pacemaker were excluded. Patients underwent post TAVR PPM if found to have high grade AV block,> 5seconds pause or symptomatic bradycardia < 50 bpm. Patients who underwent TAVR without PPM implant represented the control arm. PPM dependency was defined as > 50% pacing during 1 and 30 days post implantation. All-cause mortality was reported at one year. Of 357 patients, 16% required PPM with no difference in either balloon expandable or self-expandable valve types (14.6% vs 17.6%; P=0.471). The mean age was 80 + 8.2 years, and 52.7% were male. The median time to PPM implantation was 2 days. The main indications were complete AV block (67%) and symptomatic bradycardia (8.8%). 56.1% received a dual chamber, 24.6% a single chamber and 8.8% received a biventricular PPM. At day 1 and 30 days following implant 73.7% and 78.9% of patient fulfilled criteria for PPM dependency. There were no difference in mortality between the cohorts at one year (Fig. 1). 78% of patients requiring PPM post TAVR were pace dependent at 30 days. PPM implantation did not have an impact on mortality at 1 year. Indications for acute pacing predicted PPM dependency at 30 days and support the selection criteria used for PPM implantation in this cohort.