Influence of Prosthesis Position on Pacing Burden and Long-Term Survival in TAVI Patients with New Pacemaker

Objectives: The aim of this study was to evaluate the influence of three-dimensional transcatheter heart valve (THV) position on mid-term pacing burdens and to examine the effect of stimulation rates on survival after transcatheter aortic valve implantation (TAVI). Methods: In patients receiving a new PPM before discharge after TAVI, we analyzed the final three-dimensional THV position in 107 patients (78 with Sapien S3 THV and 29 with Evolut R THV) using fusion imaging from pre- and post-TAVI computed tomography angiography. The PPM stimulation rates were examined pre-discharge and after 3 months. Patient survival was tracked over a period of 5 years. Results: A high pacing burden (stimulation rate of >20%) was observed in 69% of patients before discharge and in 67% after three months. One-third of the patients with an initial low pacing burden developed a high pacing burden after 3 months. The implantation depth did not differ between patients with or without a high pacing burden at discharge (p = 0.550) or after 3 months (p = 0.901). The three-dimensional THV position showed no influence on the pacing burden pre-discharge (p = 0.550) and after 3 months (0.901). There were no significant differences in survival, regardless of the pacing burden pre-discharge and after 3 months (log-rank p = 0.676). Conclusions: Three-dimensional THV position did not predict a high pacing burden after TAVI. Pacing burden was not associated with survival. One-third of patients experienced an increase to a high pacing burden within 3 months, suggesting potential long-term conduction system damage after TAVI.