Hi, my name is Patrick Badertscher. I'm from the University Hospital in Basel, and I'm talking today about an analysis from the SwissTAVI registry.

What is the reasoning behind the SwissTAVI registry?

TAVI has become a first-line therapy for the treatment of severe symptomatic aortic stenosis. Identification is now expanding to a younger patient population with a lower surgical risk. And despite major advancements in TAVI technologies as well as TAVI implantation techniques, the most frequent complications remain conduction disorders, potentially leading towards pacemaker implantation.

At the moment, there's conflicting data regarding the impact of pacemaker therapy after TAVI. That's why we asked ourselves the question if patients requiring a pacemaker after TAVI have a worse prognosis.

What was the study design and patient population?

So in Switzerland, the Swiss Federal Office of Public Health mandates heart valve centres performing TAVI to enrol patients into a nationwide registry and it mandates them to perform follow up. The registry has a centralised event education and a centralised database.

For this analysis, we gathered data from 19 centres in Switzerland and we were able to assess a total of 13,000 patients. We then stratified the patients into three groups: first, patient with no pacemaker therapy; second, in patients with a pacemaker therapy within 30 days after TAVI; and third, patients who received a pacemaker prior to TAVI.

What were the key findings?

We found that patients receiving pacemaker therapy within 30 days after TAVI had a significant worse prognosis compared to patients with no pacemaker therapy in regards to all-cause death and cardiovascular death at one-year follow up.

These findings were mirrored when using extended follow-up data at five and 10 years. There were significant differences compared to patients with prior pacemaker therapy.

Regarding our secondary endpoints, we saw that patients receiving a pacemaker therapy within 30 days after TAVI had significantly more often a decline in left ventricular ejection fraction or heart failure symptoms during follow up.

What are your take-home messages for practice?

The question now remains if conduction system pacing—a novel form of pacing—could partially reverse these findings. In addition, it highlights that we need novel approaches to better risk stratify patients after TAVI and to really find out who needs a pacemaker.

What further research is needed, and what are the next steps?

The next step is to look at the type of pacing. At the moment, we included all types of pacemaker. So in the next step we want to look at if patients with cardiac resynchronisation therapy or patients with conduction system pacing also have a worse prognosis or if they have a similar prognosis than patients with no pacemaker therapy.

It's important to identify patients that do need pacing after TAVI and in patients where we can have a more conservative strategy, probably with prolonged monitoring.