One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

Abstract Objectives Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI. Methods We performed a systematic search in PUBMED, EMBASE and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Studies data, patients and procedural characteristics were extracted. Odds ratio (OR) with 95% CI were extracted. Results Data from 23 studies were obtained that included 18 610 patients. The crude incidence of PPI after TAVI was 17% (range 8.8% - 32%). PPI occurred at a median time of 3.2 days (range 0-30 days). Pacing dependency at 1-year was 47,5% (range 7% - 89%). Self-expandable prosthesis (pooled OR was 2.14 (1.15-3.96)) and baseline right bundle branch block (RBBB) (pooled OR was 2.01 (1.06-3.83)) showed 2-fold higher risk to maintain PPI dependency at 1 year after TAVI. Conclusions Although PPI represent a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short-term.