Pacemaker after TAVI is associated with worse outcomes

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A study in JACC: Cardiovascular Interventions indicates that patients who require a pacemaker after undergoing transcatheter aortic valve implantation (TAVI) often have worse outcomes than those who did not need a pacemaker. It shows that the risks are both short- and long-term and include lengthier hospital and intensive care unit stays as well as a greater risk of death.

Using data from the STS/ACC TVT Registry, Opeyemi Fadahunsi (Dalhousie University, Halifax, Nova Scotia, Canada) and others analysed patients undergoing TAVI in the USA at 229 sites between November 2011 and September 2014 to see how permanent pacemaker implantation after having TAVI affected them (at the time the study was conducted, Fadahunsi served at Reading Health System, West Reading, USA). Of the 9,785 study participants, 651 needed a permanent pacemaker within 30 days of the TAVI procedure. Those who needed a permanent pacemaker had a slightly longer hospital stay as well as longer reported hours in the intensive care unit. They also had an increased risk of death from any cause at one year. Additionally, Fadahunsi et al found that the combination of death from any cause or heart failure hospitalisations was increased at one year.

Fadahunsi comments: “While TAVI is a great advance in medical care, cardiologists need to better understand both how to prevent patients from developing heart rhythm problems and why patients who need pacemakers in the setting of recent TAVI have worsened outcomes. We found in our study that the need for a pacemaker was more common in certain valve types and larger-sized valves, in those undergoing the procedure at an older age, and those who were sicker.”