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Background <p>Previous studies reported increased mortality and rehospitalization rates in patients undergoing transcatheter aortic valve replacement (TAVR) with prior pacemaker (PM) therapy. However, the impact of different pre-existing cardiac implantable electronic devices (CIEDs), including PM and implantable cardioverter-defibrillators (ICD) and their implications on clinical outcomes after TAVR remains unclear.</p> Objectives <p>This multicenter, retrospective study aimed to evaluate the association between pre-existing CIEDs and clinical outcomes after TAVR.</p> Methods <p>We analyzed data from 1,334 patients who underwent TAVR at three German tertiary care centers. Patients with pre-existing CIEDs (PM, <i>n</i> = 358 and ICD, <i>n</i> = 58) were compared with patients without a CIED (<i>n</i> = 918). PM patients were further stratified by indication (sick sinus syndrome (SSS) vs. atrioventricular block (AVB)). Primary endpoint was all-cause mortality at 3&#xa0;years. Propensity score matching (PSM) was conducted as a sensitivity analysis for ICD patients, and a subgroup analysis was performed in patients with reduced left ventricular ejection fraction (LVEF) &lt; 50%.</p> Results <p>In the overall cohort, patients with pre-existing CIEDs had higher 3-year mortality rates (no device: 28.5% vs. PM: 35.8% vs. ICD: 50.0%; <i>p</i> &lt; 0.001). Patients with PM implanted for AVB exhibited significantly higher mortality than those with PM for SSS (39.8% vs. 29.2%; log-rank <i>p</i> = 0.030), despite comparable baseline characteristics. In PSM cohort, mortality differences were attenuated but persisted (ICD: 52.1%, PM-AVB: 45.8%, no device: 31.0%, PM-SSS: 31.3%; log-rank <i>p</i> = 0.045). In patients with reduced LVEF &lt; 50% (<i>n</i> = 332), intergroup mortality differences were no longer statistically significant (log-rank <i>p</i> = 0.243).</p> Conclusion <p>Pre-existing CIEDs, particularly ICDs and PMs implanted for AVB, were associated with increased mid-term mortality following TAVR. These differences were no longer evident in patients with reduced LVEF. Notably, patients with PMs for SSS had outcomes comparable to those without a CIED.</p> Graphical abstract <p></p>

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Impact of pre-existing CIED on mid-term mortality in patients undergoing TAVR

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Mustafa Mousa Basha,
  • Christopher Gestrich,
  • Vincent Knappe,
  • Baravan Al-Kassou,
  • Marcel Weber,
  • Raphael Phinicarides,
  • Saif Zako,
  • Thomas Beiert,
  • Farhad Bakhtiary,
  • Sebastian Zimmer,
  • Malte Kelm,
  • Stephan Baldus,
  • Nikolaus Marx,
  • Georg Nickenig,
  • Victor Mauri,
  • Tobias Zeus,
  • Jasmin Shamekhi

摘要

Background

Previous studies reported increased mortality and rehospitalization rates in patients undergoing transcatheter aortic valve replacement (TAVR) with prior pacemaker (PM) therapy. However, the impact of different pre-existing cardiac implantable electronic devices (CIEDs), including PM and implantable cardioverter-defibrillators (ICD) and their implications on clinical outcomes after TAVR remains unclear.

Objectives

This multicenter, retrospective study aimed to evaluate the association between pre-existing CIEDs and clinical outcomes after TAVR.

Methods

We analyzed data from 1,334 patients who underwent TAVR at three German tertiary care centers. Patients with pre-existing CIEDs (PM, n = 358 and ICD, n = 58) were compared with patients without a CIED (n = 918). PM patients were further stratified by indication (sick sinus syndrome (SSS) vs. atrioventricular block (AVB)). Primary endpoint was all-cause mortality at 3 years. Propensity score matching (PSM) was conducted as a sensitivity analysis for ICD patients, and a subgroup analysis was performed in patients with reduced left ventricular ejection fraction (LVEF) < 50%.

Results

In the overall cohort, patients with pre-existing CIEDs had higher 3-year mortality rates (no device: 28.5% vs. PM: 35.8% vs. ICD: 50.0%; p < 0.001). Patients with PM implanted for AVB exhibited significantly higher mortality than those with PM for SSS (39.8% vs. 29.2%; log-rank p = 0.030), despite comparable baseline characteristics. In PSM cohort, mortality differences were attenuated but persisted (ICD: 52.1%, PM-AVB: 45.8%, no device: 31.0%, PM-SSS: 31.3%; log-rank p = 0.045). In patients with reduced LVEF < 50% (n = 332), intergroup mortality differences were no longer statistically significant (log-rank p = 0.243).

Conclusion

Pre-existing CIEDs, particularly ICDs and PMs implanted for AVB, were associated with increased mid-term mortality following TAVR. These differences were no longer evident in patients with reduced LVEF. Notably, patients with PMs for SSS had outcomes comparable to those without a CIED.

Graphical abstract