Prognostic Role of Ventricular Pacing Burden in Patients with Pacemaker Implantation After TAVR

<i>Background and Objectives:</i> Permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) is common, yet the prognostic implications of ventricular pacing (VP) burden remain uncertain. <i>Materials and Methods:</i> We retrospective single-center cohort study included 118 patients undergoing TAVR who required new PPM implantation. Using X-tile analysis, patients were stratified into two groups, VP < 85% and VP ≥ 85%, at 1 month. Baseline characteristics, post-procedural outcomes, echocardiographic parameters, and long-term endpoints were compared. The primary endpoint was all-cause mortality; the secondary endpoint was a composite of mortality and first heart failure (HF) hospitalization. <i>Results:</i> At 1 month, 73 patients (61.9%) had VP < 85% and 45 (38.1%) had VP ≥ 85%. Baseline demographics were similar, but patients with VP ≥ 85% had higher LVEF (59.4 ± 4.2 vs. 49.4 ± 6.7%, <i>p</i> < 0.001), lower creatinine (0.8 vs. 1.0 mg/dL, <i>p</i> = 0.016), and higher e-GFR (69.6 ± 20.6 vs. 60.4 ± 19.8, <i>p</i> = 0.017). Time to PPM implantation was shorter in the VP ≥ 85% group (2.6 ± 1.3 vs. 6.2 ± 2.6 days, <i>p</i> < 0.001). During a median follow-up of 315 ± 105 days, mortality did not differ between groups (HR: 1.81, 95% CI: 0.76-4.31, <i>p</i> = 0.182). However, VP ≥ 85% was associated with a higher incidence of the secondary endpoint (HR: 2.36, 95% CI: 1.21-4.58, <i>p</i> = 0.012). Echocardiographic follow-up revealed lower LVEF and higher e-SPAP at 1 year in the VP ≥ 85% group (both <i>p</i> < 0.001). <i>Conclusions:</i> In TAVR patients requiring PPM, a high VP burden (≥85%) was not associated with increased mortality but predicted a higher risk of HF hospitalization and deterioration in echocardiographic parameters.