Pacemakers and length of stay in trans-aortic catheter implantation

Introduction

In mid-2019, our institution started a more strict policy regarding electrophysiological studies (EPS) and pacemaker (PM) implantations post trans-catheter aortic valve implantation (TAVI). This approach led to a shortened length of stay (LOS), which can benefit patients and be cost-effective. We aimed to examine whether this approach increased post-discharge complications.

Methods

A single-center, retrospective cohort study was performed. Consecutive 428 patients undergoing TAVI between January 2018 and November 2020 were included in the study. We split patients into two groups based on the change of policy date. The long-LOS groups included 255 patients, and the short-LOS group included 173 patients. The primary endpoints were 30-day mortality and the combined outcome of 30-day mortality, pacemaker implantation, syncope requiring hospitalization, and cardiopulmonary resuscitation. Secondary outcomes were pacemaker implantation, syncope requiring hospitalization, and cardiopulmonary resuscitation in 30-days.

Results

Baseline characteristics were similar. The short LOS group was slightly younger (78.61±10.57 in short LOS vs. 81.21±6.12, p=0.001), and fewer patients had New-York Heart Association (NYHA) 3 and 4 (71.7% vs. 87.1%, p<0.001). There was no difference in 30-day mortality between the groups (HR 1.06 [0.25-4.54], p=0.939). There was no difference in the combined 30-day outcome of mortality, pacemaker implantation, syncope, and cardiopulmonary resuscitation. There were no differences in periprocedural complications. Patients with short-stay were less likely to receive an in-hospital pacemaker (OR 0.32 [0.13-0.71], p<0.008).

Discussion

Shortening the length of stay for TAVI patients may have been considered risky in the past due to the possible arrhythmic complications and the frail baseline condition of patients. Our study shows that stiffer criteria for pacemaker implantation or electrophysiological studies (EPS) shorten hospital stay and do not increase the risk of dangerous arrhythmic events or mortality in the 30 days following discharge. Early discharge should be considered safe.