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Updated: Sep 16, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Incidence and Predictors of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement:
Mohamed N Al Rawahi1, Adil Al Kindi2, Ahmed Al Yarubi3
1Department of Medicine, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman.
Objectives:
This study aims to evaluate the predictors and rate of permanent pacemaker (PPM) implantation among patients undergoing transcatheter aortic valve replacement (TAVR) at two institutions in Oman. TAVR has become the standard of care for patients with severe aortic stenosis at high risk for surgery. However, it is associated with a high PPM implantation rate.
Methods:
This was a retrospective study involving all patients undergoing TAVR at two leading cardiac centres in Oman over seven years, from May 2013 to September 2020. We included patients who survived the procedure to discharge and those who were followed-up for at least 1 year post-procedure.
Results:
A total of 153 patients (mean age = 74.2 ± 8.2 years; 82 males [53.6%]) were enrolled in the study. Of these, 15 patients (age = 74.3 ± 9.8 years, 46.6% male) required a permanent pacemaker within 1 year of follow-up, giving a pacemaker implantation rate of 9.8% following TAVR in the cohort. The factors that predicted the requirement of a pacemaker were pre-existing right bundle branch block (odds ratio [OR] = 10.9, 95% confidence interval [CI]: 3.31-36.33; P < 0.001); abnormal QRS axis (OR = 9.11, 95% CI: 2.77-29.91; P < 0.001); prolonged QRS duration (OR = 3.26, 95% CI: 1.06-9.92; P = 0.03); and any pre-existing conduction abnormality (OR = 1.18, 95% CI: 1.08-1.29; P = 0.01).
Conclusions:
The PPM implantation rates post-TAVR at two Omani institutions are comparable to those reported in the literature. Close rhythm surveillance is crucial, especially in patients with any of the predictors identified above, for the timely identification of susceptible patients who might require PPM implantation.
