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September 18, 2026Heart RhythmOpen Access

TAVR depth below the His bundle is linked to ~25% higher pacing odds per millimeter.

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Key result

Implant position relative to the His-Purkinje axis is a dominant determinant of outcomes in TAVR and conduction-system pacing, with pacing odds rising 25% per millimeter below the His bundle in TAVR.

Authors

HJHasan JilaihawiKEKenneth A. EllenbogenPVPugazhendhi Vijayaraman

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Overview

Supports depth-guided TAVR to lower pacemaker rates; leaves open prospective validation for conduction-system pacing gains.

Key Points

  • To evaluate how anatomical positioning relative to the His-Purkinje conduction axis differentially dictates procedural success and clinical outcomes in transcatheter aortic valve replacement versus conduction-system pacing.
  • Synthesized multicenter and single-center clinical data evaluating valve implantation depth relative to the membranous septum and His bundle during transcatheter aortic valve replacement (TAVR).
  • Analyzed pacing capture characteristics and left ventricular ejection fraction gains relative to distance from the left bundle branch origin and endocardium in conduction-system pacing (CSP).
  • Evaluated emerging computed tomography protocols that reconstruct the patient-specific His-Purkinje conduction axis prior to intervention.
  • In TAVR, pacemaker implantation rates stand at approximately 16% in multicenter registries, whereas tailored depth planning relative to membranous septum length achieves rates of 3% to 5%, with pacing odds increasing 25% per millimeter implanted below the estimated His bundle.
  • In CSP, each millimeter placed closer to the left bundle branch origin confers a 0.25% absolute increase in ejection fraction, while each millimeter closer to the left ventricular endocardium adds a 0.63% absolute increase, especially in patients with reduced baseline systolic function.

PICO

P
Population
Transcatheter aortic valve replacement (TAVR) and conduction-system pacing (CSP)
E
Exposure / Comparator
Implant position relative to the His-Purkinje axis

Cite This Study

Jilaihawi et al. (2026) conducted a review in Transcatheter aortic valve replacement (TAVR) and conduction-system pacing (CSP). Implant position relative to the His-Purkinje axis was evaluated. Implant position relative to the His-Purkinje axis is a dominant determinant of outcomes in TAVR and conduction-system pacing, with pacing odds rising 25% per millimeter below the His bundle in TAVR.

synapsesocial.com/papers/6aacf64c0c46fbdff987ddadhttps://doi.org/10.1016/j.hrthm.2026.09.009
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