TY - JOUR
T1 - Prophylactic Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement
AU - Fischer, Quentin
AU - Nombela-Franco, Luis
AU - Muntané-Carol, Guillem
AU - Veiga, Gabriela
AU - Regueiro, Ander
AU - Nazif, Tamim
AU - Serra, Vicenç
AU - Asmarats, Lluis
AU - Ribeiro, Henrique B.
AU - Latib, Azeem
AU - Poulin, Anthony
AU - Cheema, Asim N.
AU - Tirado-Conte, Gabriela
AU - Gomez-Hospital, Joan Antoni
AU - Gil Ongay, Aritz
AU - Gabani, Rami
AU - Arzamendi, Dabit
AU - Brener, Michael
AU - Calabuig, Alvaro
AU - Scotti, Andrea
AU - Gelain, Marco Antonio S.
AU - Labinaz, Marino
AU - Cepas-Guillén, Pedro
AU - Côté, Mélanie
AU - del Portillo, Juan H.
AU - Philippon, François
AU - Rodés-Cabau, Josep
N1 - Publisher Copyright:
© 2025 American College of Cardiology Foundation
PY - 2025/11
Y1 - 2025/11
N2 - Background: The management of patients developing new conduction disturbances after transcatheter aortic valve replacement (TAVR) remains largely debated. Objectives: The purpose of this study was to evaluate the incidence and clinical impact of prophylactic permanent pacemaker implantation (PPI) after TAVR. Methods: This was a prespecified subanalysis of the PROMOTE (PRospective Application of a Pre-Specified Scientific Expert Panel AlgOrithm for the Management of COnduction Disturbances Following Transcatheter Aortic Valve Replacement) trial, a prospective multicenter study including 2,110 consecutive patients without prior pacemaker undergoing TAVR. Prophylactic PPI was considered in case of enlarged QRS with active electrocardiogram changes (daily PR or QRS interval increase ≥20 ms during 2 consecutive days), or new-onset persistent with either QRS>150 ms or PR >240 ms. Results: A total of 329 patients with PPI post-TAVR were included, 80 (24.3%) of which had a prophylactic indication. The main indication (90%) of prophylactic PPI was new-onset persistent left bundle branch block with QRS >150 ms and/or PR >240 ms. The 30-day clinical outcomes were similar in prophylactic and nonprophylactic PPI patients, but the median rate of ventricular pacing percentage was significantly lower in the prophylactic PPI group (2% vs 73%; P < 0.001), with a higher rate of patients with ventricular pacing percentage <1% (42.6% vs 14.5%; P < 0.001). Prophylactic PPI after a positive electrophysiological study (His-Ventricle interval ≥70 ms) did not seem to impact the pacing burden at follow-up (median: 2.0% vs 1.9% in no electrophysiological study patients; P = 0.585). Conclusions: About one fourth of patients receiving PPI after TAVR had a prophylactic indication. Despite similar clinical outcomes, prophylactic PPI patients exhibited a very low pacing burden at 30 days. These findings would question the systematic use of prophylactic PPI after TAVR.
AB - Background: The management of patients developing new conduction disturbances after transcatheter aortic valve replacement (TAVR) remains largely debated. Objectives: The purpose of this study was to evaluate the incidence and clinical impact of prophylactic permanent pacemaker implantation (PPI) after TAVR. Methods: This was a prespecified subanalysis of the PROMOTE (PRospective Application of a Pre-Specified Scientific Expert Panel AlgOrithm for the Management of COnduction Disturbances Following Transcatheter Aortic Valve Replacement) trial, a prospective multicenter study including 2,110 consecutive patients without prior pacemaker undergoing TAVR. Prophylactic PPI was considered in case of enlarged QRS with active electrocardiogram changes (daily PR or QRS interval increase ≥20 ms during 2 consecutive days), or new-onset persistent with either QRS>150 ms or PR >240 ms. Results: A total of 329 patients with PPI post-TAVR were included, 80 (24.3%) of which had a prophylactic indication. The main indication (90%) of prophylactic PPI was new-onset persistent left bundle branch block with QRS >150 ms and/or PR >240 ms. The 30-day clinical outcomes were similar in prophylactic and nonprophylactic PPI patients, but the median rate of ventricular pacing percentage was significantly lower in the prophylactic PPI group (2% vs 73%; P < 0.001), with a higher rate of patients with ventricular pacing percentage <1% (42.6% vs 14.5%; P < 0.001). Prophylactic PPI after a positive electrophysiological study (His-Ventricle interval ≥70 ms) did not seem to impact the pacing burden at follow-up (median: 2.0% vs 1.9% in no electrophysiological study patients; P = 0.585). Conclusions: About one fourth of patients receiving PPI after TAVR had a prophylactic indication. Despite similar clinical outcomes, prophylactic PPI patients exhibited a very low pacing burden at 30 days. These findings would question the systematic use of prophylactic PPI after TAVR.
KW - conduction disturbances
KW - left bundle branch block
KW - permanent pacemaker
KW - sudden cardiac death
KW - transcatheter aortic valve implantation
UR - https://www.scopus.com/pages/publications/105018026784
UR - https://www.scopus.com/pages/publications/105018026784#tab=citedBy
U2 - 10.1016/j.jacep.2025.07.028
DO - 10.1016/j.jacep.2025.07.028
M3 - Article
C2 - 40965381
AN - SCOPUS:105018026784
SN - 2405-500X
VL - 11
SP - 2484
EP - 2492
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 11
ER -