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

Clinical research in cardiology : official journal of the German Cardiac Society

Authors: 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

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.

© 2026. The Author(s).

PMID: 42329404

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