Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement.

Background: A high burden of right ventricular pacing (RVP) increases the risk of hospitalization because of heart failure. Data on predictive factors for high burden of RVP in patients with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) are limited.

Objective: This study aimed to identify predictors of high RVP burden in patients with current indications for PPI after TAVR.

Methods: We included consecutive patients who underwent PPI after TAVR between 2013 and 2023 at our institution. Dual-chamber pacemakers were programmed with an algorithm favoring spontaneous atrioventricular (AV) conduction. High burden of RVP was defined as a pacing percentage of > 20% (> 20% ventricular pacing [VP]) at 3- to 12-month follow-up.

Results: Among 193 patients included, 92 (47.7%) had > 20% VP at 3- to 12-month follow-up. Male gender (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.31-4.67), permanent atrial fibrillation (OR 2.49, 95% CI 1.01-6.15), and high-degree AV block as the indication for PPI (OR 5.05, 95% CI 2.32-11.0) were independent predictors of > 20% VP. A HAS risk score predicting > 20% VP was derived, including high-degree AV block (2 points), permanent atrial fibrillation (1 point), and male sex (1 point). A score of ≥ 3 identified a 68% prevalence of > 20% VP. Over a median follow-up of 27.7 months, > 20% VP was associated with a higher risk of all-cause mortality or heart failure hospitalization (hazard ratio 2.03, 95% CI 1.09-3.81, = .03).

Conclusion: A high RVP burden of > 20% can be anticipated using a readily available pre-PPI risk assessment. The HAS risk score may assist clinicians in determining the most appropriate VP strategy for patients after TAVR with an indication for PPI.