Incidence of new Permanent Pacemaker Implantation after Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation and Its Impact on 1-Year Mortality—Insights from the German Aortic Valve Registry

Objectives: The aim of this analysis was to evaluate the incidence of new permanent pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) and investigate its influence on 1-year mortality.

Methods: Patients who were enrolled in the German Aortic Valve Registry (GARY) undergoing isolated SAVR or TAVI between 2011 and 2015 were analyzed. The rate of NPMI was analyzed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year survival.

Results: A total of 17,750 patients who underwent SAVR and 20,872 patients who received TAVI were included in this study. The rate of NPMI was 3.6% after SAVR and 16.6% after TAVI. In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis (HR 1.55 [95% CI 1.08–2.22], p = 0.02), while after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29 [0.88–1.89], p = 0.19). In the TAVI group, NPMI was associated with an increased risk for 1-year mortality in univariable analysis as well (HR 1.29 [1.18–1.41], p < 0.001). This association persisted after multivariable adjustment (HR 1.29 [1.16–1.43], p < 0.001). A 30-day mortality was not affected by NPMI in both procedure groups.

Conclusion: The need for NPMI was markedly higher after TAVI compared with SAVR and was independently associated with increased 1-year mortality after TAVI but not after SAVR. As 30-day mortality was not affected by NPMI, the additional procedure of NPMI does not seem to be responsible for this finding. Further research is necessary to investigate underlying mechanisms.