Impact of TAVR on pacemaker dependency in patients with pre-existing devices: predictors and one-year outcomes

Background Pacemaker dependency and the impact of ventricular pacing burden after Transcatheter Aortic Valve Replacement (TAVR) in patients with pre-existing pacemakers remain poorly defined. Objectives To assess changes in pacemaker dependency after TAVR, identify predictors of 1-month dependency, and evaluate whether Ventricular Pacing (VP) % ≥40% predicts 1-year clinical outcomes. Methods We performed a retrospective cohort study of consecutive patients with symptomatic severe aortic stenosis and a preexisting permanent pacemaker who underwent TAVR at a single center between 2010 and 2024. Pacemaker interrogation was performed before TAVR, at 1 month, and at 6–12 months. Pacemaker dependency was defined as ventricular pacing percentage (VP%) >80% with a programmed lower rate of 60 bpm in VVI or DDD mode. Predictors of 1-month dependency were assessed using Firth penalized logistic regression. For 1year outcomes (stroke, heart failure hospitalization, allcause mortality, and newonset atrial fibrillation), patients were stratified by VP% ≥40% at 1 month, and timetoevent analyses were performed using Royston–Parmar flexible parametric models or Cox regression. Results Among 102 patients analyzed, 53% were pacemakerdependent before TAVR, increasing to 75% at 1 month and 69% at 6–12 months. In multivariable analysis, preprocedural QRS duration was the only strong independent predictor of 1month dependency (odds ratio [OR] 1.07 per 1ms increase; 95% CI 1.02–1.11; p=0.001), whereas baseline dependency, QTc interval, and annulus perimeter were not significant. A ventricular pacing burden ≥40% at 1 month was not significantly associated with 1year stroke, heart failure hospitalization, or allcause mortality. There was a association with newonset atrial fibrillation (adjusted hazard ratio 7.29; 95% CI 1.98–9.16; p=0.043). Conclusions Pacemaker dependency is common and increases after TAVR. Baseline QRS duration predicts 1-month dependency. VP% ≥40% at 1 month was not associated with 1-year mortality, stroke, or heart failure hospitalization but may relate to higher atrial fibrillation risk.