Same-Day Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Conduction disturbances requiring permanent pacemaker implantation (PPI) are a primary complication following transcatheter aortic valve replacement (TAVR).
• Persistent complete or high-degree atrio-ventricular block (CHB/HAVB) after TAVR necessitates careful management strategies.

Purpose of the Study:

• To evaluate the impact of same-day PPI in patients who develop persistent CHB/HAVB during TAVR.
• To compare outcomes between immediate and delayed pacemaker implantation in this patient cohort.

Main Methods:

• A multicenter study involving consecutive patients undergoing TAVR without prior pacemakers.
• Prospective collection of baseline, procedural, and follow-up data, including pacing interrogations.
• Stratification into same-day PPI (SDP) and non-same-day PPI (n-SDP) groups.

Main Results:

• Of 584 patients, 157 (26.9%) received SDP and 427 (73.1%) were observed. 88% of the observed group eventually required PPI.
• The SDP group had a shorter hospitalization length (5 vs. 8 days) with no increase in periprocedural complications.
• One-month follow-up showed similar pacing burdens and pacemaker dependency rates between SDP and n-SDP groups.

Conclusions:

• Same-day PPI is a safe strategy for TAVR patients with persistent CHB/HAVB.
• SDP is associated with reduced hospitalization duration and high pacing burden at 30 days.
• The low rate of conduction recovery in the non-implanted group supports early intervention.