Background
Conduction disturbances requiring permanent pacemaker implantation (PPI) are frequent after transcatheter aortic valve implantation (TAVI) and remain a clinical concern. However, the extent of mid-term pacemaker dependency and pacing burden is not fully understood.
Methods
This retrospective, single-center study included 2.630 consecutive patients undergoing TAVI between 2016 and 2022. A total of 281 patients (self-expanding valve [SEV] n = 162; balloon-expandable valve [BEV] n = 119) required new PPI following TAVI and underwent detailed rhythm analysis. Baseline rhythm characteristics—complete left bundle branch block (LBBB), complete right bundle branch block (RBBB), first-degree AV block (AV I°), and the need for post-dilatation—were recorded. Mid-term conduction disturbances and pacing burden after SEV and BEV were assessed for comparative analysis.
Results
Baseline conduction abnormalities were distributed as follows for SEV vs. BEV: LBBB 17.3% vs. 21.0% (p=.391), RBBB 33.3 vs. 30.3% (p=.229), AV I° 21.0% vs. 18.8% (p=.653). Post-dilatation was more common in SEV (21.3% vs. 6.0%; p < .001). Post-implant AV block III° occurred in 24.6% after SEV and 9.6% after BEV (p = .039). PPI was required in 12% of SEV and 9.1% of BEV patients (p=.11).
At early follow-up (0–14 days), pacing burden exceeded 80% in 77% (SEV) and 72% (BEV), while < 20% pacing was observed in 11% (SEV) and 17% (BEV). By 330–400 days, this pattern had shifted markedly: only 40% (SEV) and 33% (BEV) remained > 80% paced, while the proportion with < 20% pacing rose to 60% (SEV) and 33% (BEV). Thus, both valve types demonstrated a substantial reduction in pacing dependency over time. Subgroup analysis confirmed parallel pacing trends across conduction types. At 0–14 days, > 80% pacing occurred in 67 % (LBBB), 80% (RBBB), and 89% (AV I°) after SEV, and in 63%, 82%, and 73% after BEV. By 330–400 days, only RBBB patients after SEV (33%) and AV I° after BEV (50%) remained > 80% paced, while others showed < 20% pacing, indicating consistent recovery of AV conduction across subgroups.
No statistically significant difference between SEV and BEV was observed in pacing dependency (p = 0.164).
Conclusion
Conduction disturbances like LBBB, RBBB, AV I° and need for post-dilatation are frequent in patients at risk for conduction disturbances after TAVI and may guide early PPI decisions, but their association with mid-term pacing dependency appears incidental.
Overall pacing burden declined to 48% by 12 months, corresponding to 46% in SEV and 49% in BEV recipients, indicating marked recovery of intrinsic conduction in both valve groups. However, persistent high pacing dependency was predominantly observed in SEV recipients with baseline RBBB and in BEV recipients with baseline AV I°, in whom one-third and one-half, respectively, remained > 80 % paced at follow-up. Further analyses are warranted to identify subgroups—particularly those with baseline conduction abnormalities—at risk for long-term pacing dependency.
