Sex differences in permanent pacemaker implantation after transcatheter aortic valve replacement: a systematic review and meta-analysis

ABSTRACT

Background

There is limited evidence on the effect of sex on permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). The primary objective of this meta-analysis was to determine the role of sex among patients requiring PPMI post-TAVR.

Methods

A literature search was conducted using the SCOPUS, MEDLINE, and CINAHL databases for studies published until October 2022. Eligible studies included published randomized controlled trials (RCTs) and Observational Cohort Studies (OCS) articles that reported PPMI as an outcome of pacemaker status following TAVR. This study was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Publication bias was estimated using a Funnel plot and Egger’s test. Data were pooled using a random-effects model. The primary endpoint was the sex difference in PPMI after TAVR, with odds ratios and 95% confidence intervals (CIs) extracted.

Results

Data was obtained from 63 studies, and a total of 79,655 patients were included. The cumulative PPMI rate was 15.5% (95% CI, 13.6%-17.7%). The pooled analysis revealed that while there were more females than males undergoing TAVR (51.6%, 95% CI 50.4%-52.8%), males have a 14.5% higher risk for post-TAVR PPMI than females (OR 1.145, 95% CI 1.047–1.253, P < 0.01).

Conclusions

Males are more likely to experience PPMI after TAVR than females. Further research needs to be done to better explain these observed differences in outcomes.

KEYWORDS:

• Transcatheter aortic valve replacement
• permanent pacemaker implantation
• sex differences
• meta-analysis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Frederick Berro Rivera: Conceptualization, Methodology, Software. Frederick Berro Rivera, Sung Whoy Cha, John Paul Aparece, Jacques Simon T. Gonzales, Wailea Faye C. Salva: Data curation, Writing- Original draft preparation. Sung Whoy Cha, John Paul Aparece, Vikram Sharma, Abdullah Al-Abcha: Visualization, Investigation. Annabelle Santos Volgman, Fareed Moses S. Collado: Supervision. Sung Whoy Cha, John Paul Aparece: Software, Validation. Michael Lawrenz Co, Azeem Latib, Nathan Ross B. Bantayan, Genquen Philip Carado, Annabelle Santos Volgman: Writing, Reviewing and Editing.

SUPPLEMENTARY MATERIAL

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2250719

Additional information

Funding

This paper was not funded.