Predictors and timing of pacemaker implantation after TAVI: a retrospective analysis of early and late cases

Abstract Introduction Pacemaker implantation (PI) is a frequent complication following transcatheter aortic valve implantation (TAVI) due to its impact on the heart’s conduction system. The European Society of Cardiology advises at least seven days of monitoring, often extending hospital stays. Purpose To evaluate differences between early and late PI using our centre’s median time to implantation and identify potential predictors of late PI. Methods We performed a retrospective, single-centre study on TAVI patients from March 2020 to September 2023. Patients were grouped into early PI (≤2 days), late PI (3–30 days), and no PI within 30 days. Those with a prior pacemaker were excluded. Baseline characteristics were analysed, and binary logistic regression was used to identify predictors of late PI, after excluding early PI cases. Results Among our cohort of 542 patients, 67 (12.4%) underwent early PI and 51 (9.4%) required late PI. Patients in the early PI group were older (mean age 83.1 ± 5.4 years, p=0.021) and demonstrated a higher prevalence of right bundle branch block (RBBB) (37.9%, p0.001). In the late PI group, there was a trend toward higher rates of type 2 insulin-treated diabetes and dialysis-dependent chronic kidney disease. Notably, while pre-existing left bundle branch block (LBBB) did not influence the risk of PI, the development of de novo LBBB following TAVI was strongly associated with late PI. Regarding valve types, the Accurate Neo2 prosthesis showed no significant association with PI, whereas the Navitor valve was correlated with late PI, and the Evolut valve was associated with early PI. Comparing early and late PI, the early group was linked to pre-existing RBBB and Evolut valve use, while the latter was associated with post-TAVI de novo LBBB and Navitor valve use. After excluding early PI cases, binary logistic regression identified de novo LBBB (OR 1.926, CI 1.001–3.706, p=0.050), Navitor valve use (OR 3.152, CI 1.495–6.644, p=0.003), and dialysis-dependent chronic kidney disease (OR 18.048, CI 1.530–212.878, p=0.022) as significant predictors of late PI. Conclusion Determining the optimal discharge timing after TAVI requires a thorough assessment of conduction disturbances. Our results suggest that patients with de novo LBBB, those with a Navitor valve implantation, and dialysis-dependent patients may require closer monitoring and possibly longer observation periods. Table 2