Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>This study aimed to assess the impact of pacemaker mode programming on clinical outcomes in patients with high‐degree atrioventricular conduction disturbance (AVCD) after transcatheter aortic valve implantation (TAVI).</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>Although high‐degree AVCD after TAVI can receive pacemaker, recovery of the AVCD is often observed. Specific pacemaker algorithms (AAI‐DDD mode switch) are available which favor spontaneous atrioventricular conduction.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Of 1,621 consecutive multi‐center TAVI patients, 269 (16.4%) received pacemaker. We retrospectively included 91 patients with persistent high‐degree AVCD at hospital discharge. Pacemaker dependency was defined as absence, inadequate intrinsic ventricular rhythm, or ventricular pacing time > 95% on pacemaker interrogation during follow‐up. Comparison of heart failure hospitalization and death between conventional DDD (cDDD) and other modes was examined (AAI‐DDD and VVI).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During a mean follow‐up duration of 13 months, the pacemaker dependency rate was 52.8%. Patients with cDDD mode (N = 36: 40.0%) had significantly more pacemaker dependency. Multivariate analysis showed that cDDD mode was independently associated with pacemaker dependency (odds ratio = 3.63, <jats:italic>P</jats:italic> = 0.03). Moreover, cDDD patients had a significant higher incidence of heart failure hospitalization (Hospitalization: cDDD vs. others = 45.4% vs. 18.2%, <jats:italic>P</jats:italic> = 0.03) and had a higher incidence of mortality (Death: cDDD vs. the others = 27.0% vs. 4.4%, <jats:italic>P</jats:italic> = 0.06).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Up to half of patients implanted for high‐degree AVCD after TAVI had conduction recovery. Patients with cDDD programming at hospital discharge had more pacemaker dependency and a worse cardiac prognosis. Thus, pacemaker mode should be systematically set to promote spontaneous atrioventricular conduction in patients with pacemaker implantation after TAVI.</jats:p></jats:sec>