Pacemaker dependency after transcatheter aortic valve implantation: a 15-year single-centre experience
F Mashood, S H Kamsani, N H Am Haris, F A Haris, T Y Sin, Z Ali, N A Sahat, A Ahmad Said, R Rebo, H J Mohamed Zamberi, N A H Mohd Nizam, K Gurupparan, S A Yahaya, S K Khalae, A HussinAbstract
Background / Introduction
High grade atrio-ventricular block remains a common conduction-related complication following transcatheter aortic valve implantation (TAVI). However, long-term pacemaker dependency (PD) among TAVI recipients who undergo permanent pacemaker (PPM) implant is variable, and regional data from Southeast Asia are scarce. Understanding PD is essential, as persistent reliance on right-ventricular pacing may predispose to pacing-induced cardiomyopathy and influence clinical follow-up.
Purpose
To evaluate the prevalence, temporal pattern, and potential predictors of pacemaker dependency in patients undergoing PPM implantation after TAVI.
Methods
This retrospective single-centre study included all TAVI procedures performed between November 2009 and June 2025 (n=232) at a national cardiac referral centre. Patients who received a PPM within 1 year of TAVI (n=31) formed the study cohort. Pacemaker dependency was assessed using device interrogation. Clinical, electrocardiographic (ECG), and procedural variables were analyzed. Continuous variables were expressed as mean ± SD or median [IQR], and associations were explored using univariate statistics.
Results
Of 232 TAVI patients, 31 (13.4%) received PPM within 1 year. Among these, 19 patients (61.3%) were pacemaker-dependent, and 12 (38.7%) maintained intrinsic conduction. The median time to dependency assessment was 1 [1–2] month. Pre-TAVI ECGs in PD patients showed sinus rhythm (42.1%) and RBBB (21.1%), while post-TAVI complete heart block dominated (73.7%). PD patients structural parameters and baseline LVEF were comparable between groups. CT-derived measurements, including annular dimensions, calcium distribution, and cusp-specific calcification, showed no significant differences between dependent and non-dependent patients. No clinical, ECG, echocardiographic, or CT variables demonstrated independent predictive value for pacemaker dependency.
Conclusion
Pacemaker dependency was common among patients requiring PPM after TAVI, yet no clinical, ECG, echo, or CT variables reliably predicted long-term reliance on pacing. These findings highlight the unpredictable nature of conduction recovery and the need for larger datasets to refine predictor models.Study flowchartParameters and long term outcomes