Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement
Background: A high burden of right ventricular pacing (RVP) increases the risk of hospitalization because of heart failure. Data on predictive factors for high burden of RVP in patients with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) are limited. Objec...
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| Format: | Article |
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Elsevier
2025-08-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501825001862 |
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| author | Frédéric Anselme, MD, PhD Iliès Jaballah, MD Arnaud Savoure, MD Raphaël Al Hamoud, MD Charles Fauvel, MD Eric Durand, MD, PhD Hélène Eltchaninoff, MD, PhD Corentin Chaumont, MD, PhD |
| author_facet | Frédéric Anselme, MD, PhD Iliès Jaballah, MD Arnaud Savoure, MD Raphaël Al Hamoud, MD Charles Fauvel, MD Eric Durand, MD, PhD Hélène Eltchaninoff, MD, PhD Corentin Chaumont, MD, PhD |
| author_sort | Frédéric Anselme, MD, PhD |
| collection | DOAJ |
| description | Background: A high burden of right ventricular pacing (RVP) increases the risk of hospitalization because of heart failure. Data on predictive factors for high burden of RVP in patients with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) are limited. Objective: This study aimed to identify predictors of high RVP burden in patients with current indications for PPI after TAVR. Methods: We included consecutive patients who underwent PPI after TAVR between 2013 and 2023 at our institution. Dual-chamber pacemakers were programmed with an algorithm favoring spontaneous atrioventricular (AV) conduction. High burden of RVP was defined as a pacing percentage of > 20% (> 20% ventricular pacing [VP]) at 3- to 12-month follow-up. Results: Among 193 patients included, 92 (47.7%) had > 20% VP at 3- to 12-month follow-up. Male gender (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.31–4.67), permanent atrial fibrillation (OR 2.49, 95% CI 1.01–6.15), and high-degree AV block as the indication for PPI (OR 5.05, 95% CI 2.32–11.0) were independent predictors of > 20% VP. A H2AS risk score predicting > 20% VP was derived, including high-degree AV block (2 points), permanent atrial fibrillation (1 point), and male sex (1 point). A score of ≥ 3 identified a 68% prevalence of > 20% VP. Over a median follow-up of 27.7 months, > 20% VP was associated with a higher risk of all-cause mortality or heart failure hospitalization (hazard ratio 2.03, 95% CI 1.09–3.81, P = .03). Conclusion: A high RVP burden of > 20% can be anticipated using a readily available pre-PPI risk assessment. The H2AS risk score may assist clinicians in determining the most appropriate VP strategy for patients after TAVR with an indication for PPI. |
| format | Article |
| id | doaj-art-03b6b2f1ff644f479ce9588e09c3d263 |
| institution | Kabale University |
| issn | 2666-5018 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj-art-03b6b2f1ff644f479ce9588e09c3d2632025-08-24T05:14:47ZengElsevierHeart Rhythm O22666-50182025-08-01681070107610.1016/j.hroo.2025.05.024Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacementFrédéric Anselme, MD, PhD0Iliès Jaballah, MD1Arnaud Savoure, MD2Raphaël Al Hamoud, MD3Charles Fauvel, MD4Eric Durand, MD, PhD5Hélène Eltchaninoff, MD, PhD6Corentin Chaumont, MD, PhD7Department of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, Rouen, France; Address reprint requests and correspondence: Dr Frédéric Anselme, Department of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, CHU – Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen Cedex, France.Department of Cardiology, Rouen University Hospital, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, Rouen, FranceDepartment of Cardiology, Rouen University Hospital, UNIROUEN, INSERM U1096, Rouen, FranceBackground: A high burden of right ventricular pacing (RVP) increases the risk of hospitalization because of heart failure. Data on predictive factors for high burden of RVP in patients with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) are limited. Objective: This study aimed to identify predictors of high RVP burden in patients with current indications for PPI after TAVR. Methods: We included consecutive patients who underwent PPI after TAVR between 2013 and 2023 at our institution. Dual-chamber pacemakers were programmed with an algorithm favoring spontaneous atrioventricular (AV) conduction. High burden of RVP was defined as a pacing percentage of > 20% (> 20% ventricular pacing [VP]) at 3- to 12-month follow-up. Results: Among 193 patients included, 92 (47.7%) had > 20% VP at 3- to 12-month follow-up. Male gender (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.31–4.67), permanent atrial fibrillation (OR 2.49, 95% CI 1.01–6.15), and high-degree AV block as the indication for PPI (OR 5.05, 95% CI 2.32–11.0) were independent predictors of > 20% VP. A H2AS risk score predicting > 20% VP was derived, including high-degree AV block (2 points), permanent atrial fibrillation (1 point), and male sex (1 point). A score of ≥ 3 identified a 68% prevalence of > 20% VP. Over a median follow-up of 27.7 months, > 20% VP was associated with a higher risk of all-cause mortality or heart failure hospitalization (hazard ratio 2.03, 95% CI 1.09–3.81, P = .03). Conclusion: A high RVP burden of > 20% can be anticipated using a readily available pre-PPI risk assessment. The H2AS risk score may assist clinicians in determining the most appropriate VP strategy for patients after TAVR with an indication for PPI.http://www.sciencedirect.com/science/article/pii/S2666501825001862TAVRTAVIPacemakerRight ventricular pacing burdenPacing-induced cardiomyopathy |
| spellingShingle | Frédéric Anselme, MD, PhD Iliès Jaballah, MD Arnaud Savoure, MD Raphaël Al Hamoud, MD Charles Fauvel, MD Eric Durand, MD, PhD Hélène Eltchaninoff, MD, PhD Corentin Chaumont, MD, PhD Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement Heart Rhythm O2 TAVR TAVI Pacemaker Right ventricular pacing burden Pacing-induced cardiomyopathy |
| title | Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| title_full | Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| title_fullStr | Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| title_full_unstemmed | Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| title_short | Prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| title_sort | prediction and impact of high burden of ventricular pacing in patients with pacemaker after transcatheter aortic valve replacement |
| topic | TAVR TAVI Pacemaker Right ventricular pacing burden Pacing-induced cardiomyopathy |
| url | http://www.sciencedirect.com/science/article/pii/S2666501825001862 |
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