Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation

<i>Purpose</i>. Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with longer life expectancies. The need for permanent pacemaker implantation (PPI) following TAVI has been associated with increased all-cause mortality and morbidity. This study aimed to identify ECG, CT, and procedural predictors of PPI following TAVI. <i>Methods.</i> We conducted a retrospective observational study at the University Hospital of North Norway. Patients who underwent TAVI with SAPIEN 3 or SAPIEN 3 Ultra valves were included, while those with prior pacemakers, self-expanding valves, or valve-in-valve procedures were excluded. Data were collected from medical records, pre-operative CT scans, and procedural angiography. <i>Results.</i> A total of 416 low- to intermediate-risk patients with a median age of 82 years were included. Of these, 64 patients (15.4%) required PPI within ≤30 days following the index procedure. Multivariable regression analysis identified the following predictors for PPI: pre-existing right bundle branch block (odds ratio (OR), 10.7; 95% CI, 4.74–24.3), first-degree atrioventricular block (OR, 2.62; 95% CI, 1.08–6.32), membranous septum length (OR, 0.77; 95% CI, 0.65–0.90), left ventricular outflow tract calcification (OR, 2.18; 95% CI, 1.12–4.27), and the use of 29 mm valves (OR, 2.33; 95% CI, 1.09–4.97). <i>Conclusions.</i> Our study found the following predictors of PPI following TAVI: pre-existing right bundle branch block, first-degree atrioventricular block, the use of 29 mm valves and the presence of left ventricular outflow tract calcification. Additionally, a short MS was found to increase the chance of PPI; therefore, MS measurements should be included in pre-operative assessments to identify at-risk patients.