Recovery of atrioventricular conduction after transcatheter aortic valve replacement: A single center experience

INTRODUCTION: Limited data are available on long-term changes in the conduction system following transcatheter aortic valve implantation (TAVI). OBJECTIVE: To assess atrioventricular (AV) conduction changes after TAVI and examine the relationship between pacemaker (PM)-derived parameters and surface ECG findings. METHODS: We retrospectively analyzed patients who underwent PM implantation after TAVI between July 2014 and June 2023. Demographic, imaging, procedural, and ECG data were collected. A dedicated follow-up (FU) visit, including device interrogation and a 12-lead ECG recorded during temporary VVI pacing at 30 bpm, was performed on average 1.7 ± 1.3 years post-implant. Based on FU ECGs, patients were classified as having persistent (persAVB) or regressive AV block (regrAVB). RESULTS: Among 377 TAVI procedures, 33 PM implantations (8.7%) were performed at a mean of 5.7 days after the procedure. Indications included third-degree AV block in 27 (81%), second-degree AV block in 3 (9%), and significant bradycardia in 3 (9%). FU ECGs were available for 14 patients; 7 (50%) showed conduction recovery. Baseline QRS duration was significantly wider in persAVB than in regrAVB (107.1 ± 27.3 ms vs. 80.7 ± 1.6 ms; p = 0.038). Median right ventricular pacing (RVp) burden was substantially higher in persAVB (100% [IQR 98.8-100%]) compared with regrAVB (0% [IQR 0-2.5%]; p < 0.001). Pacemaker dependency was present in 28% of persAVB patients and in none of the regrAVB group. CONCLUSIONS: A substantial proportion of patients showed recovery of AV- conduction over time, particularly those without pre-existing conduction disturbances. The degree of RVp closely reflected conduction recovery status during follow-up.