Structure 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.