Abstract
Background: In-hospital permanent pacemaker implantation (PPMI) is a
frequent and well-known complication of transcatheter aortic valve
replacement (TAVR) procedure. The period of monitoring for need for
pacing after discharge remains poorly understood. Methods: The National
Readmission Database from first six months of calendar year 2016 and
2017 was queried for patient discharged alive after TAVR. All patients
with prior pacemakers were excluded. Patients who received pacemaker
after discharge (d-PPMI) were compared to a) patients receiving no
pacemaker (o-PPMI) or b) patients receiving pacemaker on index
admission(i-PPMI) over a 6 month follow-up. Results: Out of 39,993
patients who did not have a prior pacemaker, 4001(10.0%) underwent PPM
implantation during index admission (i-PPMI) while over the next 6
months, a further 734 (1.8%) patients underwent the procedure (d-PPMI).
For patients receiving PPMI during follow-up post TAVR discharge, the
majority (68%) occurred within 14 days. The primary cause of
readmission for d-PPMI was heart block in majority of the cases (73%;
complete heart block 49%, second degree heart block 4%,
bradycardia/other heart block 20%). The d-PPMI group also had a
relatively shorter length of stay and a lower comorbidity burden when
compared to the i-PPMI group. When compared to the o-PPMI group, the
d-PPMI group were more likely to have higher advanced heart block.
Conclusions: About one-fifth of pacemakers implanted post TAVR
procedures happen during follow-up with a majority of them happening
immediately after discharge. Risk stratification at discharge may help
to identify patients who undergo PPMI post discharge.