Key result
Intraprocedural third-degree AVB predicts ~107-fold higher odds of 30-day pacemaker dependency post-TAVI.
Why the study?
The optimal timing of permanent pacemaker implantation after TAVI remains debated, and evidence on long-term pacemaker dependency and its relationship with intensive care unit admission is limited.
Does the type and timing of conduction disturbance predict pacemaker dependency at 30 days in patients undergoing permanent pacemaker implantation post-TAVI?
Observational (n=227)
No
Does the type and timing of conduction disturbance predict pacemaker dependency at 30 days in patients undergoing permanent pacemaker implantation post-TAVI?
Odds Ratio: 107.3 (95% CI 20.6–1982)
p-value: p=<0.001
Intraprocedural third-degree AV block strongly predicts 30-day pacemaker dependency post-TAVI, suggesting these patients may benefit from same-day permanent pacemaker implantation to reduce ICU admissions.
Intraprocedural AVB may identify high pacemaker dependency risk; hypothesis-generating for risk models, needs prospective validation.
Background Conduction disturbances requiring permanent pacemaker implantation (PPI) remain a frequent complication following transcatheter aortic valve implantation (TAVI), with important clinical implications. The 2021 ESC Guidelines on cardiac pacing recommend at least 24-48h monitoring before permanent pacemaker implantation but optimal timing of PPI remains debated. While several predictors of implantation have been identified, evidence on long-term pacemaker dependency and its relationship with intensive care unit (ICU) admission is still limited. Objective The primary endpoint of this study was the incidence and predictors of permanent pacemaker dependency at 30-day follow-up We evaluate the association between prevalent arrhythmia post-TAVI and the risk of long-term pacemaker dependency and the need for ICU admission. Methods We conducted a retrospective, single-centre observational study including 227 patients who underwent PPI following TAVI between 2009 and 2024. Pacemaker dependency was assessed at 30 days. Univariable and multivariable logistic regression models were used to identify predictors of dependency. Associations with ICU admission were evaluated using Fisher’s exact test. Subgroup analysis was performed according to the predominant arrhythmia prompting PPI. Results Pacemaker dependency at 30 days was significantly associated with intraprocedural third-degree atrioventricular block (AVB) (73%), followed by postprocedural third-degree AVB (53%) and Mobitz II AVB (33%). Intraprocedural AVB carried the highest independent risk of dependency (OR 107.3; 95% CI 20.6–1982.0; p<0.001). Pacemaker dependency was also strongly associated with ICU admission (OR 2.41; p=0.02). The onset timing of conduction disturbances provided significant prognostic value beyond traditional predictors. Conclusions Early identification of patients at high risk of pacemaker dependency post TAVI, may support prompt PPI, including same-day PPI , reducing ICU admissions and related risks. In this context, conduction system pacing techniques such as LBBAP represent a promising strategy to optimize ventricular synchrony and may improve long-term outcomes in post-TAVI patients.
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Marsilia et al. (2026) conducted an observational in Conduction disturbances requiring permanent pacemaker implantation following TAVI (n=227). Intraprocedural third-degree atrioventricular block was evaluated on Permanent pacemaker dependency at 30-day follow-up (OR 107.3, 95% CI 20.6-1982.0, p=<0.001). Intraprocedural third-degree atrioventricular block was the strongest independent predictor of pacemaker dependency at 30 days post-TAVI (OR 107.3; 95% CI 20.6-1982.0; p<0.001).
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