Mortality after cardiac resynchronization therapy or right ventricular pacing in transcatheter aortic valve replacement recipients

Johannes Kirchner; Muhammed Gerçek; Vanessa Sciacca; Jan-Christian Reil; Denise Guckel; Max Potratz; Hazem Omran; Kai Friedrichs; Thomas Eitz; Sabine Bleiziffer; Rene Schramm; Guram Imnadze; Christian Sohns; Jan Gummert; Volker Rudolph; Tanja K Rudolph; Philipp Sommer; Thomas Fink

doi:10.1007/s00392-024-02450-1

Mortality after cardiac resynchronization therapy or right ventricular pacing in transcatheter aortic valve replacement recipients

Clin Res Cardiol. 2024 May 2. doi: 10.1007/s00392-024-02450-1. Online ahead of print.

Authors

Johannes Kirchner¹, Muhammed Gerçek¹, Vanessa Sciacca², Jan-Christian Reil¹, Denise Guckel², Max Potratz¹, Hazem Omran¹, Kai Friedrichs¹, Thomas Eitz³, Sabine Bleiziffer³, Rene Schramm³, Guram Imnadze², Christian Sohns², Jan Gummert³, Volker Rudolph¹, Tanja K Rudolph¹, Philipp Sommer², Thomas Fink⁴

Affiliations

¹ Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany.
² Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany.
³ Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany.
⁴ Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Universitätsklinik (Ruhr-Universität Bochum), Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany. thomas_fink47@gmx.de.

PMID: 38695900
DOI: 10.1007/s00392-024-02450-1

Abstract

Background: Permanent pacemaker implantation (PMI) is associated with increased morbidity after transcatheter aortic valve replacement (TAVR). Cardiac resynchronization-therapy (CRT) is recommended for patients if left ventricular ejection fraction (LVEF) is ≤ 40% and ventricular pacing is expected in favor to sole right ventricular (RV) pacing. Meanwhile, LVEF may recover after TAVR in patients with aortic valve disease and the benefit of CRT is unknown.

Objective: To analyze the impact of CRT implantation as compared to RV pacing after TAVR.

Methods and results: Between 2012 and 2022, 4385 patients (53.1% female, mean age 81 ± 6 years) without prior PMI undergoing TAVR were retrospectively identified in our institutional registry. After stratification of patients in LVEF ≤ 40%, 41-49% and ≥ 50%, Kaplan-Meier analysis revealed significantly different survival rates in each subgroup at 5 years (37.0% vs. 43.5% vs. 55.1%; P ≤ 0.021). At multivariate regression, LVEF and new PMI after TAVR were not relevant for survival. A total of 105 patients with LVEF ≤ 40% received PMI after TAVR (86 patients with RV pacing and 19 with CRT). At 5 years, all-cause mortality was significantly lower in patients with CRT-device as compared to patients without CRT-device (Kaplan Meier estimate of 21.1% vs. 48.8%; HR 0.48, CI 0.204 - 1.128; log rank p = 0.045). In multivariate analysis CRT remained a significant factor for 5-year survival in these patients (HR 0.3, CI 0.095-0.951, p = 0.041).

Conclusion: In patients undergoing TAVR, PMI did not influence 5-year survival. In patients with LVEF ≤ 40%, CRT-device implantation was associated with improved survival compared to non-CRT-device implantation.

Keywords: CRT; Heart failure; Pacemaker; Survival; TAVR.