Introduction

Permanent pacemaker implantation (PPI) is associated with worse outcome after TAVR. Cardiac resynchronization-therapy (CRT)-device implantation is recommended for patients if left ventricular ejection fraction (LV-EF) is ≤40% and ventricular pacing is expected. Meanwhile, amelioration of LV-EF is described in patients with heart failure with reduced ejection fraction (HFrEF) after TAVR. It is unclear whether CRT implantation in patients with ≤ 40% LVEF leads to a better outcome compared to non-CRT-pacemaker devices in TAVR recipients.

Methods and Results

We analyzed consecutive patients who received PPI due to high-degree AV blockage after TAVR in our center between 2012 and 2022. 4385 patients without prior permanent pacemaker implantation (PPI) were identified (53.1% female, mean age 81±6 years). Stratification of patients in LVEF ≤40%, LVEF 41–49% and LVEF ≥50%, Kaplan-Meier analysis revealed significant different survival rates in each subgroup (37.0% vs 43.5% vs. 55.1%; P≤0.021) but no difference between PPI-patients or non-PPI patients. At multivariate regression, LVEF and PPI were not relevant for 5-year survival. In patients with LVEF ≤40%, 105 patients had PPI with or without defibrillator. 86 (81.9 %) received 1- or 2 chamber non-CRT-devices and 19 (16.2 %) received a CRT-device. After 5 years, Kaplan-Meier analysis revealed that all-cause mortality was significantly lower in patients with CRT-device as compared to-patients without CRT device (21.1% vs. 48.8%; HR 0.48 CI 0.204 – 1.128; log rank P=0.045).

Conclusion

In patients undergoing TAVR, PPI did not influence 5-year survival. In patients with LVEF ≤40% CRT-device implantation was associated with improved survival compared to non-CRT-device implantation.