Key result
Early-onset complete AV block linked to ~5.5-fold higher odds of 12-month pacemaker dependency after TAVI.
Why the study?
Conduction disturbances and long-term pacemaker dependency after TAVI remain incompletely clarified, with variable evolution over time and uncertain predictors.
What are the prevalence and predictors of permanent pacemaker dependency after transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis?
Cohort (n=376)
No
What are the prevalence and predictors of permanent pacemaker dependency after transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis?
Odds Ratio: 5.48 (95% CI 1.65–18.23)
p-value: p=0.005
While pacemaker implantation remains a frequent complication after TAVI (18%), only about one-third of these patients remain pacemaker-dependent at 1 year, suggesting cautious monitoring before implantation may be warranted in some patients, though specific predictors like preexisting RBBB and early complete AV block identify those at highest risk for long-term dependency.
Pacemaker dependency resolves in most TAVI recipients by 1 year; supports selective implantation strategies but leaves open prospective validation.
Background Permanent pacemaker implantation (PPI) remains a complication of transcatheter aortic valve implantation (TAVI). The evolution of conduction disturbances and long-term pacemaker dependency (PD) still represents a matter of investigation. Objective This study aimed to study the prevalence, patients' characteristics, and predictors of PD after TAVI. Methods We analyzed consecutive patients who underwent TAVI included in a prospectively maintained single-center database. Results We included 376 patients (median age 82 years [78–84]; 51% men). Sixty-nine (18%) underwent PPI after TAVI; among those evaluated at 12 months (n = 59), 21 (36%) were PD. PD patients had preprocedure longer QRS duration (110 ms [90–130] vs 90 ms [80–100], P = .039), higher frequency of right bundle branch block (10% [48%] vs 7% [18%], P = .018), and early-onset complete atrioventricular block (AVB) (24 hours after TAVI) (16% [76%] vs 14% [37%], P = .004). Median time interval between TAVI and PPI was significantly reduced in PD patients (87 hours [54–151] vs 27 hours [31–74], P = .0005). Baseline QRS duration (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.06, P = .017), preexisting right bundle branch block (OR 4.02, 95% CI 1.23–13.18, P = .021), and complete AVB 24 hours after TAVI (OR 5.48, 95% CI 1.65–18.23, P = .005) were independent predictors of PD at 1 year, whereas early-onset complete AVB predicted PD at first follow-up. At 12 months, spontaneous heart rate was lower (0 beats per minute [0–30] vs 65 beats per minute [50–74], P < .0001), and median % of ventricular pacing was higher in PD patients (99% [98%–100%] vs 35% [3%–60%], P < .0001). Conclusion PPI is frequent after TAVI, with ∼36% of these patients being PD at 12 months. Chronic kidney disease, baseline QRS duration, and intraventricular conduction disturbances are strong predictors of the need for permanent pacemaker ventricular stimulation.
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Ponti et al. (2025) conducted a cohort in Severe symptomatic aortic stenosis (n=376). Early-onset complete atrioventricular block vs. Absence of early-onset complete atrioventricular block was evaluated on Pacemaker dependency at 12 months (OR 5.48, 95% CI 1.65-18.23, p=0.005). Among TAVI patients requiring a permanent pacemaker, 36% remained pacemaker dependent at 12 months, with early-onset complete atrioventricular block acting as a strong predictor (OR 5.48).
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