Permanent pacemaker implantation after aortic valve implantation

Aims: Conduction abnormalities are well-recognized complications following aortic valve replacement, particularly after transcatheter aortic valve implantation (TAVI). The incidence of permanent pacemaker implantation (PPI) post-TAVI remains variable, influenced by patient and procedural factors. To evaluate the incidence, clinical predictors, and outcomes associated with PPI following TAVI, with specific attention to left ventricular ejection fraction (LVEF). Methods: We conducted a retrospective analysis of 60 patients who underwent transfemoral TAVI between 2008 and 2011. Baseline demographic, clinical, procedural, and echocardiographic parameters were compared between patients who required PPI and those who did not. Univariate and bivariate analyses were used to identify potential predictors. Results: PPI was required in 29 of 60 patients (48.3%), with the majority of devices implanted within 72 hours post-procedure. Dual-chamber pacemakers were most commonly utilized, predominantly for complete atrioventricular block or symptomatic bradycardia associated with new-onset left bundle branch block. No statistically significant associations with PPI were found for variables such as age, sex, atrial fibrillation, ischemic heart disease, or baseline LVEF (all p > 0.05). Trends suggesting possible associations with atrial fibrillation and mitral regurgitation did not reach statistical significance. Conclusion: PPI remains a frequent yet unpredictable outcome after TAVI, particularly in the era of early-generation valve systems. Our findings underscore the absence of reliable clinical predictors and emphasize the need for prospective studies incorporating procedural, anatomical, and electrophysiologic markers to refine risk stratification and minimize unnecessary device implantation.