Conduction abnormalities after TAVI and their role in patient management: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Adults undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, at variable surgical risk, with reported conduction abnormalities and need for permanent pacemaker implantation. Intervention: Transcatheter aortic valve implantation (TAVI). Primary outcome: Incidence of conduction abnormalities (ECG changes) and permanent pacemaker implantation (PPM-I) following TAVI (PPM-I rates varied from 2.9%–3.5% in low-risk/no conduction abnormality groups to 18%–21% in higher-risk groups including those with pre-existing right bundle branch block (RBBB) or treated with self-expanding valves).

Ionuț Tudorancea; Irene Paula Popa; Mihai Ștefan Cristian Haba; Ștefan Popa; Viviana Aursulesei; Dragomir Nicolae Șerban; Ionela Lăcrămioara Șerban; Irina Iuliana Costache-Enache; Radu Iliescu; Cătălin Loghin

doi:10.3389/fcvm.2026.1706176

February 13, 2026SHILAP Revista de lepidopterologíaOpen Access

Conduction abnormalities after TAVI and their role in patient management: a systematic review

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Graphical abstract published by SHILAP Revista de lepidopterología — Graphical abstract · Published by SHILAP Revista de lepidopterología · CC BY

Why the study?

TAVI is associated with a relatively high incidence of permanent pacemaker implantation, prompting an evaluation of ECG changes before and after TAVI, predictors for PPM-I, and post-TAVI ECG monitoring protocols.

Do pre-existing right bundle branch block and post-TAVI electrocardiographic changes predict the need for permanent pacemaker implantation in patients undergoing TAVI?

Key Points

To assess electrocardiographic changes before and after transcatheter aortic valve implantation (TAVI) and determine predictors of permanent pacemaker implantation (PPM-I).
Conducted a systematic review of literature published between 2001 and 2024 across PubMed, Web of Science, and JSTOR databases following PRISMA guidelines.
Identified and screened 24,170 records, including 17 studies evaluating human original ECG and pacemaker data using the ROBINS-I tool to assess risk of bias.
Permanent pacemaker implantation rates ranged from 2.9%–3.5% in low-risk cohorts to 18%–21% in higher-risk populations, with pre-existing right bundle branch block acting as a strong predictor.
The most common post-TAVI abnormalities were new-onset left bundle branch block (25% to 39%), PR interval prolongation exceeding 240 ms, and QRS complex widening exceeding 150 ms.
A ≥18.9% increase in combined PR and QRS duration predicted pacemaker implantation with 63% sensitivity and 73% specificity, while high-grade AV block occurred in 4%–10% of patients.

Study Design

Type

Systematic Review

Structured PICO

Do pre-existing right bundle branch block and post-TAVI electrocardiographic changes predict the need for permanent pacemaker implantation in patients undergoing TAVI?

P

Population

Patients undergoing transcatheter aortic valve implantation (TAVI) across 17 included studies.

I

Intervention

Transcatheter aortic valve implantation (TAVI) and periprocedural electrocardiographic (ECG) monitoring

O

Outcome

Permanent pacemaker implantation (PPM-I) and electrocardiographic (ECG) changes (new-onset left bundle branch block, prolonged PR interval, and QRS complex widening)safety

Main Result

Effect estimate: PPM-I rates varied from 2.9%–3.5% in low-risk/no conduction abnormality groups to 18%–21% in higher-risk groups including those with pre-existing right bundle branch block (RBBB) or treated with self-expanding valves

Limitations

Majority of included studies were observational and single-center, limiting causality and generalizability
Heterogeneity in study designs, ECG monitoring duration, and conduction abnormality definitions
Variable follow-up durations impaired uniform assessment of long-term conduction disturbances
Lack of consistent data on newer valve platforms and fast-track TAVI protocols
Limited direct comparative data between valve types and conduction outcomes
Observational design of most included studies with moderate risk of confounding
Selection bias
Incomplete adjustment for procedural variables such as implantation depth or valve oversizing
Heterogeneity in monitoring duration and outcome definitions
Limited follow-up duration or non-continuous monitoring strategies

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Implication

Systematic periprocedural ECG monitoring is crucial during TAVI, as pre-existing right bundle branch block and post-procedural new-onset LBBB, PR prolongation, and QRS widening strongly predict the need for permanent pacemaker implantation.

Abstract

Objective Transcatheter aortic valve implantation (TAVI) is associated with a relatively high incidence of permanent pacemaker implantation (PPM-I). We aimed to evaluate the existing literature on electrocardiographic (ECG) changes before and after TAVI, identify predictors for PPM-I, and suggest a standardized post-TAVI ECG monitoring protocol. Methods A systematic literature review was conducted across multiple databases, including PubMed, Web of Science, and JSTOR, to identify studies published between 2001 and 2024. Results From an initial pool of 24,170 records, 17 studies met the inclusion criteria. Pre-existing right bundle branch block and significant prolongation of ECG intervals were identified as strong predictors of PPM-I. Following TAVI, new-onset left bundle branch block, prolonged PR interval, and QRS complex widening were the most common ECG changes. Conclusion Systematic periprocedural ECG monitoring during TAVI is of paramount importance for the early recognition of conduction abnormalities (CAs) that predict the need for PPM-I.

Cite This Study

Tudorancea et al. (2026) conducted a systematic review in Adults undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, at variable surgical risk, with reported conduction abnormalities and need for permanent pacemaker implantation. Transcatheter aortic valve implantation (TAVI) was evaluated on Incidence of conduction abnormalities (ECG changes) and permanent pacemaker implantation (PPM-I) following TAVI (PPM-I rates varied from 2.9%–3.5% in low-risk/no conduction abnormality groups to 18%–21% in higher-risk groups including those with pre-existing right bundle branch block (RBBB) or treated with self-expanding valves).

synapsesocial.com/papers/6992b42c9b75e639e9b09010 https://doi.org/10.3389/fcvm.2026.1706176

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Conduction abnormalities after TAVI and their role in patient management: a systematic review

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Conduction abnormalities after TAVI and their role in patient management: a systematic review

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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