Comparison of patients developing early versus delayed indication for permanent pacemaker implantation after transcatheter aortic valve implantation

Background/Introduction Conduction disturbances requiring permanent pacemaker (PM) implantation represent a frequent complication following transcatheter aortic valve implantation (TAVI) (1). While most cases occur during hospital admission, some patients develop delayed indications after discharge, but predictors of timing remain unclear (2). Purpose To compare clinical and procedural characteristics between patients requiring early versus delayed PM implantation after TAVI and identify potential predictive factors. Methods This retrospective study included 63 consecutive patients who underwent PM implantation following TAVI. Patients were stratified into two groups: early PM implantation (before index discharge, n=48) and delayed PM implantation (after index discharge, n=15). Clinical characteristics, procedural parameters, and anatomical measurements were compared between groups. Continuous variables were expressed as median with interquartile range and compared using appropriate non-parametric tests. Results The overall median age was 83.0 years (74.5-90.4), with 33.3% females. Intraprocedural atrioventricular block occurred significantly more frequently in the early PM group compared to delayed PM group (66.7% vs. 20.0%, p=0.001). Most common indications for PM were intraprocedural AV block (36.5%), asymptomatic bradycardia (25.4%), syncope (19.0%), and presyncope (14.3%). Baseline ECG showed right bundle branch block in 44.4%, left bundle branch block in 30.2%, and left anterior fascicular block in 23.8% of patients, with no significant differences between groups. Baseline QRS duration was 120.0 ms (98.0-150.0). There were no significant differences between groups regarding age, sex, valve type (self-expanding 68.3%), balloon dilatation rates, prosthesis oversizing, anatomical measurements, bicuspid anatomy, calcium distribution, or implantation depth. New-onset left bundle branch block after TAVI occurred in 28.6% overall, with a trend toward higher incidence in the delayed PM group (46.7% vs. 22.9%, p=0.132). Conclusions Intraprocedural AV block was the strongest predictor distinguishing early from delayed PM requirement after TAVI. Patients without intraprocedural conduction disturbances remain at risk for delayed PM need after discharge, warranting careful follow-up. Anatomical and procedural factors did not predict the timing of PM implantation.