Corticosteroid treatment before TAVI and the risk of pacemaker implantation: A 2:1 matching study

Background Conductive disorders after TAVI remain frequent, leading to a 10-20% risk of permanent pacemaker implantation (PPI). Pre-existing conduction disorders or anatomical features can offer a good prediction of the risk of PPI, however, inflammatory and hemorrhagic process are responsible of transient abnormalities and 1/3 of the patients does not need the pacemaker at follow-up. In this setting, corticosteroid could be an interesting treatment to prevent or reduce the need of PPI. We aim to assess the influence of chronic or acute corticosteroid treatment in the occurrence of PPI after TAVI. Methods All TAVI performed in our center 2013 and 2018 were prospectively included in the study. Patient treated either with chronic or acute corticosteroid before TAVI were gathered through medical database claim of the University Hospital of Dijon, France. They were matched 1:2 on sex, age, and the valve implanted. Preoperative parameters, corticosteroids dose and indication, and PPI rates after TAVI were collected. Results Among the 691 patients included, 18 (2.6%) patients had a corticosteroid prescription before TAVI procedure. 11(61%) had a chronic corticosteroid prescription, when the remaining patients were treated before and a few days after TAVI as prevention of contrast iodinated product allergy. When compared to the matched population (n = 36), no significant difference was found on PPI rates during hospitalization (2 (11%) vs. 6 (17%), P = 0.70). Among others parameters collected, the only significant difference between the two groups was that corticosteroids patients less frequently had previous diabetes (3 (17%) 17 vs. 18(50%), P = 0.021). Conclusion Corticosteroid treatment is uncommon before TAVI, reducing the statistical power of this analysis. Given the safety of this drug prescription on short duration prescription, a prospective randomized study could be performed to confirm our hypothesis.