Pacemaker dependency rates decrease within the first year of post-TAVR implantation

Introduction

High degree AV block occurs in a proportion of patients after TAVR leading to pacemaker implantation. The rate and clinical predictors of pacemaker dependency are not well established.

Objectives

The objective of this study was to determine the percentage of patients who remain pacemaker dependent at 6 weeks, 6 months, and 12 months after TAVR implantation. Secondary endpoints included patient and procedural predictors of long-term dependency.

Methods

Consecutive patients from May 2024 to October 2025 who underwent pacemaker placement at a single center within 30 days before or after TAVR were retrospectively included. Pacemaker dependency was defined as >90% ventricular pacing burden on device interrogation at follow-up. Patient comorbidity and procedural data were used to analyze predictors of long-term dependency by Chi-Square testing and Pearson correlation.

Results

Of 430 patients undergoing TAVR, 37 patients (8.6%) received pacemakers within 30 days. 45.9% of those patients (17/37) remained pacemaker dependent at 6 weeks. Dependency rates decreased to 29.7% (11/37 patients) at 6 months. At 12 months only 16.2% of patients (6/37) remained pacemaker dependent.

Pre-procedural conduction abnormalities (left bundle branch block and bifascicular block) and atrial arrhythmias (atrial fibrillation and flutter) were significant predictors of pacemaker dependency. Patients with LBBB pre-TAVR who received pacemakers post-TAVR had a 30% rate of dependency compared to 11% for patients without LBBB (p<0.01). Similar rates were observed in 33% of patients with pre-existing bifascicular block compared to 13% without (p<0.01). Patients with atrial fibrillation and/or flutter had a 25% dependency rate compared to 12% without (p<0.01). Other factors (RBBB, sex, CAD, and LVEF) had no statistically significant association with dependency.

The Self-expanding supra-annular valves (n=6) resulted in the highest rate of dependency at 33%, followed by Balloon-expandable intra-annular valves (n=22) at 14%, and Self-expanding intra-annular valves (n=9) at 11%. Analysis of valve size indicates a strong positive relationship (r=0.928) between valve width and 12-month dependency.

Conclusion

In this single center experience, the rate of periprocedural pacemaker placement was modest at 8.6%. The pacemaker dependency rate was high at 6 weeks (45.9%), but decreased to only 16.2% at 12 months, predicted by pre-existing conduction abnormalities, atrial arrhythmias, and valve type/width. These findings can help guide pacemaker choices and programming.