Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI. METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up. RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02. CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.

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Journal
International Journal of Cardiology
Published
2026-04-25
DOI
https://doi.org/10.1016/j.ijcard.2026.134525
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

Marcin Protasiewicz, Daniel Unić, Peep Laanmets, Ashokkumar Thakkar et al.
International Journal of Cardiology
Cardiac Valve Diseases and Treatments
article

Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

Marcin Protasiewicz, Daniel Unić, Peep Laanmets, Ashokkumar Thakkar, Alfonso Ielasi, Manuel Pan, Ivica Kristić, Udita Chandra, Emmanuel Teíger, Vicente Peral, Pieter C Smits, Geert A. A. Versteeg, Pedro L. Martin, Mario García Gomez, Benno J.W.M. Rensing, Ben J. L. Van den Branden, Manuel De Sousa Almeida, Matjaz Bunc, Francesco Bedogni, Bela Merkely, Mark Webster, Jürgen Rothe, Oskar Angerås, Eric van Belle, Andreas Baumbach, Tsung-Ying Tsai, Niels van Royen, Ignacio J. Amat-Santos, Axel Linke, Renicus S. Hermanides, Martin Hudec, Konstantinos Toutouzas, Michiel Voskuil, Marie-Claude Morice, Scot Garg, Yoshinobu Onuma, Won-Keun Kim, Matteo Montorfano, Fausto Feres, Akihiro Tobe, Vlasis Ninios, Patrick W. Serruys
article en

Abstract

BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI. METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up. RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02. CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.

International Journal of CardiologyVol. 456
Semmelweis University (HU), Radboud University Nijmegen (NL), Vita-Salute San Raffaele University (IT), Queen Mary University of London (GB), Ollscoil na Gaillimhe – University of Galway (IE), Université Paris-Est Créteil (FR), Université de Lille (FR), University Hospital Dubrava (HR), Sahlgrenska University Hospital (SE), Interbalkan Medical Center (GR), Ljubljana University Medical Centre (SI), Auckland City Hospital (NZ), University Medical Center Utrecht (NL), Wroclaw Medical University (PL), Cardiovascular European Research Center (FR), Instituto Maimónides de Investigación Biomédica de Córdoba (ES), North Estonia Medical Centre (EE), Hospital Universitario de Gran Canaria Doctor Negrín (ES), IRCCS Policlinico San Donato (IT), Istituto Clinico Sant'Ambrogio (IT), St. Antonius Ziekenhuis (NL), Amphia Ziekenhuis (NL), Centro de Investigación Biomédica en Red (ES), Hospital Universitario Reina Sofía (ES), Health Research Institute of the Balearic Islands (ES), Hôpitaux Universitaires Henri-Mondor (FR), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Kerckhoff Klinik (DE), Isala (NL), William Harvey Research Institute (GB), Meril Life Sciences (India) (IN), Hôpital Privé Jacques Cartier (FR), Instituto Dante Pazzanese de Cardiologia (BR), Royal Blackburn Teaching Hospital (GB), Hippocration General Hospital (GR), Herzzentrum Dresden Universitaetsklinik (DE), Cordoba University (US), AGH University of Krakow (PL), Technische Universität Dresden (DE), Universidade Nova de Lisboa (PT), University of Split (HR)
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