Key result
Self-expanding valves linked to ~4.4-fold higher temporary pacing risk during BAV TAVR.
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Why the study?
Recovery from conduction disturbances and progression to permanent pacemaker implantation after TAVR in bicuspid aortic valve patients is poorly characterized.
What is the rate of conduction disturbance recovery, and what predicts permanent pacing requirement post-TAVR in patients with bicuspid aortic valves?
Cohort (n=307)
No
What is the rate of conduction disturbance recovery, and what predicts permanent pacing requirement post-TAVR in patients with bicuspid aortic valves?
Nearly half of BAV patients requiring temporary pacing during TAVR recover without needing a permanent pacemaker, suggesting that extended monitoring is warranted before proceeding to permanent implantation.
BACKGROUND AND PURPOSE Conduction disturbances (CD) are a common complication of transcatheter aortic valve replacement (TAVR), and patients with bicuspid aortic valves (BAV) seem particularly vulnerable. Whether temporary CD recover or progress to permanent pacemaker (PPM) implantation is poorly characterized in patients with BAV. We characterized recovery from intra-procedural conduction injury and predictors of recovery versus progression to permanent pacing. METHODS We retrospectively analyzed 307 BAV patients without prior PPM who underwent TAVR at a single center (February 2014-June 2025). Multivariable models were adjusted for age, sex, prior atrial fibrillation, coronary artery disease, aortic-valve calcium volume, and device type; peripheral vascular disease was added in the within-TempPM Firth-penalized model owing to complete separation. RESULTS Temporary pacemaker (TempPM) placement was required in 60 patients; 28 (46.7%) recovered without PPM. Peripheral vascular disease (PVD) was the strongest predictor of non-recovery (p = 0.027), with prior atrial fibrillation showing a similar trend (p = 0.053). Sievers Type 1, specifically the left-right coronary-fusion subtype (L-R), showed higher TempPM use (OR 7.18, p = 0.003). Self-expanding valves also increased TempPM risk (OR 4.41, p = 0.012). Among patients without peri-procedural CD, delayed PPM (11, 4.5%) was predicted only by advanced age (OR 1.08, p = 0.035). CONCLUSIONS Nearly half of BAV patients with peri-procedural conduction injury recover without permanent pacing, supporting extended monitoring before committing to PPM implantation. Peripheral vascular disease and prior atrial fibrillation identify patients unlikely to recover and may guide earlier PPM placement. Sievers Type 1 L-R morphology and advanced age are associated with conduction risk and should inform pre-procedural planning.
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Alhallak et al. (2026) conducted a cohort in Bicuspid aortic valves requiring transcatheter aortic valve replacement (TAVR) (n=307). Self-expanding valves vs. Non-self-expanding valves was evaluated on Temporary pacemaker (TempPM) risk (OR 4.41, p=0.012). Nearly half (46.7%) of BAV patients requiring a temporary pacemaker post-TAVR recovered without permanent pacing, while self-expanding valves increased temporary pacing risk (OR 4.41, P=0.012).
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