Conduction disturbances following transcatheter aortic valve implantation: clinical predictors and prognostic implications of post-procedural pacemaker implantation
F Mashood, S H Kamsani, N H Am Haris, F A Haris, T Y Sin, Z Ali, N A Sahat, A Ahmad Said, M H Aziman, R Rebo, H J Mohamed Zamberi, K Gurupparan, S A Yahaya, S K Khalae, A HussinAbstract
Background/Introduction
Transcatheter Aortic Valve Implantation (TAVI) is an established therapy for severe aortic stenosis. However, conduction disturbances remain among its most frequent complications. A proportion of patients develop high-grade atrioventricular block requiring permanent pacemaker (PPM) implantation, which may impact long-term ventricular function and mortality. Identifying markers that predict PPM requirement is essential to guide post-procedural monitoring and management.
Purpose
To determine the prevalence of PPM implantation after TAVI and identify predictors associated with PPM requirement. Secondary aims included evaluating pacemaker-induced cardiomyopathy (PICM), and mortality outcomes.
Methods
This retrospective cohort study included 232 consecutive patients undergoing TAVI at our National Heart Institute, between November 2009 and June 2025. Patients with PPM implantation ≤100 days prior to TAVI were excluded. Clinical data, pre- and post-TAVI ECG findings, and device interrogation results were analyzed. Logistic regression was used to identify independent predictors of PPM implantation. The primary endpoint was PPM implantation within 30 days post-TAVI; secondary endpoints included pacing burden, 1-year mortality, and PICM.
Results
Out of 232 patients, 31 (13.4%) required PPM implantation within 1 year following TAVI. Multivariable analysis demonstrated that pre-TAVI right bundle branch block was a strong independent predictor of PPM requirement. Post-procedural complete heart block and new onset LBBB was also significantly associated with subsequent device implantation, reflecting its severity and persistence despite observation. Among patients who received a PPM, nearly half exhibited a high ventricular pacing burden exceeding 40% during follow-up. Although statistical significance was not reached, patients with higher pacing burden experienced a greater incidence of pacemaker-induced cardiomyopathy at one year and showed a trend toward increased all-cause mortality compared with those without PPM implantation.
Conclusion(s)
Pre-TAVI ECG RBBB, post-TAVI ECG complete heart block, and new-onset LBBB were the strongest ECG-based predictors of PPM requirement. High ventricular pacing burden following implantation was associated with increased risk of PICM. These findings support intensified rhythm surveillance and early risk stratification in patients exhibiting these conduction abnormalities.Logistic regression analysisLong term outcomes