Permanent pacemaker implantation occurred in 18.4% of TAVI patients, with 38% pacemaker dependency at 12 months, predicted by RBBB, CKD, baseline QRS duration, and early AV block.
What are the prevalence and predictors of permanent pacemaker dependency at 12 months following TAVI?
Nearly 40% of patients who require a permanent pacemaker after TAVI remain pacemaker-dependent at 1 year, driven by baseline conduction abnormalities and early post-procedural AV block.
Abstract Introduction Permanent pacemaker implantation (PPI) remains a relevant complication following transcatheter aortic valve implantation (TAVI). The evolution of conduction disturbances, and long-term pacemaker dependency (PD) still represent a matter of investigation. Purpose To study the prevalence, patients’ characteristics and predictors of PD after TAVI. Methods We analyzed consecutive patients who underwent TAVI (January 2022-November 2024) included in a prospectively maintained single-center database. Clinical, electrocardiographic (baseline, 24, 48 hours after TAVI, discharge), and procedural variables were systematically collected. Pacemaker interrogations were repeated at 1 and 12 months. PD was defined as the absence of intrinsic ventricular rhythm ≥30 bpm upon reducing the pacing rate to 30 bpm for at least 10" or following transient inhibition of pacing. Results We included 376 patients (median age 8278-84 years; 51% men). Sixty-nine (18.4%) underwent PPI after TAVI. There were no significant differences related to the use of self-expandable vs balloon-expandable valves. Pre-dilatation (OR95%CI:3.491.53-7.99, p=0.003), new-onset left bundle branch block (OR95%CI:5.542.43-12.63, p0.001), and pre-existing right bundle branch block - RBBB (OR95%CI:20.687.10-60.23, p0.001) were independent predictors of PPI at univariate and multivariate logistic regression analyses. Among patients undergoing PPI and surviving at 12 months follow-up (n=61), 23 (38%) were PD. They did not show significant differences in terms of clinical (except for a higher prevalence of chronic kidney disease - 39%vs16%, p=0.040), echocardiographic or procedural features compared to those not PD at follow-up. However, they showed significant ECG differences at baseline (i.e., longer QRS duration - 110 90-140 msec vs 90 80-100 msec, p=0.025; and RBBB - 1252% vs 821%, p=0.012), and after the procedure (early-onset i.e., 24h after TAVI complete AV-block - 1774% vs 1642%, p=0.016). Median time interval between TAVI and PPI was significantly reduced in PD patients. (8754-151 hours vs. 2731-74 hours, p=0.0005). Chronic kidney disease (OR95%CI:3.421.02-11.48, p=0.046), baseline QRS duration (OR95%CI:1.031.00-1.06, p=0.015), pre-existing RBBB (OR95%CI:4.091.32-12.67, p=0.015), and new-onset complete AV block after TAVI (OR95%CI:4.091.32-12.67, p=0.015) were independent predictors of PD at univariate logistic regression analysis. At 12 months follow-up, spontaneous heart rate was lower (00-30 bpm vs. 6550-70 bpm, p0.0001), and median % of ventricular pacing was higher in PD patients (9998-100% vs 353-65%, p0.0001). Conclusions PPI is frequent after TAVI, with ~40% of these patients being PD at 12 months. Pre-existing AV and intraventricular conduction disturbances together with the early onset of a complete AV block after TAVI seem to be powerful predictors of the need for permanent pacemaker ventricular stimulation.
Ponti et al. (2025) studied this question. Permanent pacemaker implantation occurred in 18.4% of TAVI patients, with 38% pacemaker dependency at 12 months, predicted by RBBB, CKD, baseline QRS duration, and early AV block.
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