Permanent Pacemaker Implantation After TAVI and Its Association with Survival: Single-Center Cohort and Nationwide Validation

<b>Background/Objectives:</b> Permanent pacemaker (PM) implantation is a well-recognized complication of transcatheter aortic valve implantation (TAVI), but its long-term prognostic impact remains uncertain. To evaluate the association between PM implantation and all-cause mortality in TAVI recipients. <b>Methods:</b> We performed a post hoc analysis of a prospective single-center TAVI registry (2016-2020). The primary endpoint was all-cause mortality at 1 and 5 years. Cox regression and Kaplan-Meier analyses were applied. Validation was performed using the nationwide AUTHEARTVISIT claims database. <b>Results:</b> Among 1114 consecutive TAVI patients (mean age 81 ± 5.8 years; 49.8% female), 120 (10.8%) had a pre-existing PM (Pre-PM), and 153 (13.7%) received a new PM within 30 days post-TAVI (Post-PM). Post-PM patients were older (<i>p</i> = 0.006), more often male (<i>p</i> < 0.001), had higher Troponin T levels (<i>p</i> = 0.002), more pre-existing right bundle branch block (<i>p</i> < 0.001), and longer QRS duration (<i>p</i> < 0.001) compared to patients without PM. In multivariate analysis, one-year mortality was associated with Troponin T (<i>p</i> = 0.002) and NT-proBNP (<i>p</i> = 0.002) serum levels. Pre- or Post-PM status was not associated with 1-year mortality (<i>p</i> = 0.455, <i>p</i> = 975). However, Pre-PM status was independently associated with 5-year mortality (HR 1.4, 95% CI: 1.0-1.9, <i>p</i> = 0.03), whereas Post-PM status was not (HR 1.2, 95% CI: 0.8-1.6, <i>p</i> = 0.22). Findings were confirmed in the nationwide AUTHEARTVISIT cohort. <b>Conclusions:</b> In this large, real-world TAVI cohort with national validation, Post-PM status was not associated with mortality at 1 or 5 years. By contrast, Pre-PM identified patients at higher long-term risk, possibly reflecting underlying cardiac disease.