Rapid Atrial Pacing After TAVI for Pacemaker Prediction

Despite continued advancements in transcatheter aortic valve implantation (TAVI) techniques, the incidence of permanent pacemaker implantation (PPI) remains substantial. Established predictors of PPI include advanced age, pre-existing electrocardiographic conduction abnormalities, prosthetic valve type, implantation depth, and anatomical parameters, such as membranous septum length, which are currently under active investigation. In routine clinical practice, the management strategy often involves the temporary placement of a transvenous pacemaker lead, followed by a period of observation. While widely implemented, this approach introduces clinical uncertainty and may contribute to prolonged hospitalization, particularly given the not infrequent occurrence of delayed high-degree atrioventricular (AV) block. A novel diagnostic method emerging from electrophysiological evaluation is rapid atrial pacing performed post-TAVI, which aims to assess susceptibility to Wenckebach-type AV block. Two observational studies have evaluated this technique, utilizing an upper pacing threshold of 120 beats per minute as a cutoff to identify patients at risk of requiring permanent pacing. Moreover, this method is cost-effective, technically straightforward, and time-efficient; preliminary findings suggest this technique possesses a high negative predictive value. However, additional prospective data are required to validate the clinical utility of this technique and inform the development of standardized implementation. An upcoming clinical study (NCT06189976) is anticipated to provide valuable insights.