Incidence and Predictors of Permanent Pacemaker Implantation After Balloon‐Expandable TAVI: Applicability of the RITMO Score

Background Permanent pacemaker implantation (PPMI) remains a common complication after transcatheter aortic valve implantation (TAVI). While the RITMO score—incorporating right bundle branch block (RBBB), membranous septum length (MSL), and aortic valve calcium load—was developed for self‐expanding valves, its performance in balloon‐expandable valves (BEVs) is uncertain. Aims To evaluate the incidence and predictors of PPMI following balloon‐expandable TAVI and to assess the applicability of the RITMO score in this valve platform. Materials and Methods We retrospectively analyzed 310 patients who underwent TAVI with balloon‐expandable Edwards Sapien valves. Baseline clinical, electrocardiographic, and MSCT data were collected, and the RITMO score was calculated for all. Independent predictors were identified using multivariable logistic regression. Results PPMI occurred in 34 patients (10.9%). Compared with the non‐PPMI group, those requiring PPMI had significantly higher rates of baseline RBBB ( p < 0.001), shorter MSL ( p = 0.002), and elevated Agatston calcium scores ( p = 0.001). In multivariable analysis, RBBB ( p < 0.001), short MSL ( p = 0.002), and high Agatston score ( p = 0.009) were independent predictors. Patients in the RITMO high‐risk category (> 1) had a 12.3‐fold higher likelihood of requiring PPMI compared with the low‐risk group (OR: 12.3, 95% CI: 5.6–27.3). The RITMO score demonstrated strong discriminatory performance (AUC: 0.839, 95% CI: 0.769–0.909, p < 0.001). Conclusions The RITMO score is a valid and effective tool for predicting PPMI after BEV‐TAVI. Its simplicity and applicability support its use in procedural planning and early risk stratification, independent of valve type.