Supplementary Material for: Predictive factors for permanent pacemaker implantation and mortality after transcatheter aortic valve replacement in patients with pre-existing atrial fibrillation

Background: Atrial fibrillation (AF) is the most common arrhythmia among patients undergoing transcatheter aortic valve replacement (TAVR). Post-TAVR permanent pacemaker implantation (PPI) predictors for patients in sinus rhythm were studied. However, scarce data is available about patients with AF. The aim of the study is to assess the prevalence of AF among patient undergoing TAVR, to identify predictors of PPI, and to study the association between PPI and long-term mortality.
Methods: A historical cohort study of all patients who underwent TAVR between 2008-2022 in a large tertiary medical center. Patients with prior aortic valve bio-prosthesis or pacemakers were excluded. 30-days PPI and 3-year mortality were studied. Univariate and multivariable analyses were performed.
Results: Of the 1,579 patients who met the inclusion criteria, 405 (25.6%) had a history of AF either paroxysmal (17.1%) or persistent (8.4%). Among them, 49.9% were male and the mean age was 82±6 years. The 30-days PPI rate was 21.7%. Right bundle branch block (RBBB, aOR 5.34, 95%CI 2.79-10.21) and CoreValve/Evolut valve (aOR 2.51, 95%CI 1.40-4.51) were significantly associated with 30-days PPI. PPI was not statistically significant associated with increased 3-year mortality.
Conclusion: AF is prevalent among TAVR patients and PPI rates among this population are high. Predictors for PPI among patients with AF are similar to prior known predictors in patients with sinus rhythm and include baseline RBBB and transcatheter heart valve type. Despite the high PPI rates, there is no association between PPI and long-term mortality among Patients with AF.

背景：心房颤动（Atrial fibrillation, AF）是接受经导管主动脉瓣置换术（transcatheter aortic valve replacement, TAVR）的患者中最常见的心律失常。既往已有研究针对窦性心律（sinus rhythm）患者的经导管主动脉瓣置换术后永久起搏器植入（permanent pacemaker implantation, PPI）预测因子展开探索，但针对合并心房颤动患者的相关临床数据仍较为匮乏。本研究旨在评估经导管主动脉瓣置换术患者中心房颤动的患病率，明确永久起搏器植入的预测因素，并探讨永久起搏器植入与长期死亡率之间的关联。
方法：本研究为一项回顾性队列研究，纳入2008年至2022年间于某大型三级医疗中心接受经导管主动脉瓣置换术的全部患者，排除既往存在主动脉瓣生物假体或永久起搏器的受试者。本研究观察了术后30天永久起搏器植入情况与3年死亡率，并采用单因素及多因素分析方法进行统计分析。
结果：共计1579例符合纳入标准的患者被纳入研究，其中405例（25.6%）存在阵发性（17.1%）或持续性（8.4%）心房颤动病史。该心房颤动亚组患者中男性占比49.9%，平均年龄为82±6岁。术后30天永久起搏器植入率为21.7%。右束支传导阻滞（right bundle branch block, RBBB，校正优势比（adjusted odds ratio, aOR）5.34, 95%置信区间（confidence interval, CI）2.79-10.21）及CoreValve/Evolut瓣膜（校正优势比（adjusted odds ratio, aOR）2.51, 95%置信区间（confidence interval, CI）1.40-4.51）均与术后30天永久起搏器植入显著相关。永久起搏器植入与3年死亡率升高未呈现统计学显著性关联。
结论：心房颤动在经导管主动脉瓣置换术患者中具有较高患病率，该人群的永久起搏器植入率亦处于较高水平。合并心房颤动患者中永久起搏器植入的预测因素与既往窦性心律患者中已知的预测因素相似，包括基线右束支传导阻滞及经导管心脏瓣膜类型。尽管该人群永久起搏器植入率较高，但合并心房颤动的经导管主动脉瓣置换术患者中，永久起搏器植入与长期死亡率并无显著关联。