Permanent pacemaker dependency after transcatheter aortic valve implantation: Prevalence, patients' characteristics, and main determinants.

Background: Permanent pacemaker implantation (PPI) remains a complication of transcatheter aortic valve implantation (TAVI). The evolution of conduction disturbances and long-term pacemaker dependency (PD) still represents a matter of investigation. Objective: This study aimed to study the prevalence, patients' characteristics, and predictors of PD after TAVI. Methods: We analyzed consecutive patients who underwent TAVI included in a prospectively maintained single-center database. Results: We included 376 patients (median age 82 years [78-84]; 51% men). Sixty-nine (18%) underwent PPI after TAVI; among those evaluated at 12 months (n = 59), 21 (36%) were PD. PD patients had preprocedure longer QRS duration (110 ms [90-130] vs 90 ms [80-100], P = .039), higher frequency of right bundle branch block (10% [48%] vs 7% [18%], P = .018), and early-onset complete atrioventricular block (AVB) (24 hours after TAVI) (16% [76%] vs 14% [37%], P = .004). Median time interval between TAVI and PPI was significantly reduced in PD patients (87 hours [54-151] vs 27 hours [31-74], P = .0005). Baseline QRS duration (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.06, P = .017), preexisting right bundle branch block (OR 4.02, 95% CI 1.23-13.18, P = .021), and complete AVB 24 hours after TAVI (OR 5.48, 95% CI 1.65-18.23, P = .005) were independent predictors of PD at 1 year, whereas early-onset complete AVB predicted PD at first follow-up. At 12 months, spontaneous heart rate was lower (0 beats per minute [0-30] vs 65 beats per minute [50-74], P < .0001), and median % of ventricular pacing was higher in PD patients (99% [98%-100%] vs 35% [3%-60%], P < .0001). Conclusion: PPI is frequent after TAVI, with ∼36% of these patients being PD at 12 months. Chronic kidney disease, baseline QRS duration, and intraventricular conduction disturbances are strong predictors of the need for permanent pacemaker ventricular stimulation.