Key result
TAVI linked to higher permanent pacemaker risk than SAVR due to procedural and anatomical factors.
Why the study?
Transcatheter aortic valve implantation carries a higher risk of conduction disturbances and permanent pacemaker implantation than surgical replacement, and integrating detailed pre-procedural imaging may improve risk stratification and planning.
Does transcatheter aortic valve implantation increase the risk of permanent pacemaker implantation compared to surgical aortic valve replacement in elderly patients with severe aortic stenosis?
Cohort (n=60)
Does transcatheter aortic valve implantation increase the risk of permanent pacemaker implantation compared to surgical aortic valve replacement in elderly patients with severe aortic stenosis?
Absolute Event Rate: 35% vs 10%
TAVI is associated with a significantly higher risk of new-onset conduction disturbances and permanent pacemaker implantation compared to SAVR, driven by procedural and anatomical factors.
Background: Cardiac conduction disturbances remain a frequent complication after aortic valve replacement, particularly following transcatheter aortic valve implantation. These disturbances may necessitate permanent pacemaker implantation and can influence post procedural outcomes, yet comparative prospective data integrating anatomical predictors remain limited. Aim: To compare the incidence and prognosis of cardiac conduction disturbances and permanent pacemaker implantation after transcatheter versus surgical aortic valve replacement, and to identify independent clinical and radiological predictors of pacemaker requirement. Method: This prospective cohort study included 60 elderly patients with severe aortic stenosis who underwent either surgical aortic valve replacement or transcatheter aortic valve implantation. Clinical, electrocardiographic, echocardiographic, and computed tomography based radiological data were collected. Patients were followed for six months to assess new onset conduction disturbances, pacemaker implantation, and clinical outcomes. Multivariable regression analysis was used to identify independent predictors of permanent pacemaker implantation. Results: Among 60 patients, 20 underwent SAVR and 40 underwent TAVI. New onset conduction disturbances were more frequent after TAVI than SAVR (45% vs 15%). Permanent pacemaker implantation occurred in 35% of TAVI patients compared with 10% after SAVR. Within TAVI, pacemaker implantation was higher with self-expandable valves than balloon expandable valves (50% vs 20%). Greater implantation depth and higher LVOT calcification were independent predictors of pacemaker implantation. Conclusion: Transcatheter aortic valve implantation is associated with a higher risk of conduction disturbances and permanent pacemaker implantation than surgical replacement, driven largely by procedural and anatomical factors. Integration of detailed pre procedural imaging may improve risk stratification and procedural planning.
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Aboshahba et al. (2026) conducted a cohort in severe aortic stenosis (n=60). Transcatheter aortic valve implantation vs. Surgical aortic valve replacement was evaluated on Permanent pacemaker implantation. Transcatheter aortic valve implantation was associated with a higher rate of permanent pacemaker implantation compared with surgical aortic valve replacement (35% vs 10%).
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