loading page

Contemporary rate of pacemaker implantation in patients discharged after TAVR
  • +6
  • Nachiket Apte,
  • Sagar Ranka,
  • Moghni Mohammed,
  • Seth Sheldon,
  • Amit Noheria,
  • Madhu Reddy,
  • Peter Tadros,
  • Sanjaya Gupta,
  • Rhea Pimentel
Nachiket Apte
University of Louisville
Author Profile
Sagar Ranka
University of Kansas Department of Cardiovascular Medicine
Author Profile
Moghni Mohammed
University of Kansas Department of Cardiovascular Medicine
Author Profile
Seth Sheldon
University of Kansas Department of Cardiovascular Medicine
Author Profile
Amit Noheria
University of Kansas Department of Cardiovascular Medicine
Author Profile
Madhu Reddy
University of Kansas
Author Profile
Peter Tadros
University of Kansas Medical Center
Author Profile
Sanjaya Gupta
St. Luke's Hospital - Mid America Heart Institue
Author Profile
Rhea Pimentel
University of Kansas
Author Profile

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.