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Updated: Sep 13, 2025
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Published on: August 8, 2025
Same-Day Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement
Quentin Fischer1, Marina Urena2, Guillem Muntané-Carol3
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Insights
Same-day permanent pacemaker implantation (PPI) is safe for patients with persistent heart block after transcatheter aortic valve replacement (TAVR). This approach shortens hospital stays without increasing complications, supporting its use in TAVR procedures.
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.
Background:
The development of conduction disturbances leading to permanent pacemaker implantation (PPI) remains the main complication of transcatheter aortic valve replacement (TAVR).
Objectives:
The aim of this study was to determine the impact of same-day PPI in patients developing persistent complete or high-degree atrio-ventricular block (CHB/HAVB) during TAVR.
Methods:
This was a multicenter study including consecutive patients without prior pacemaker and developing procedural persistent CHB/HAVB. Baseline, procedural, and follow-up clinical and pacing interrogation data were prospectively collected in a dedicated database.
Results:
A total of 584 consecutive patients (mean age: 81 ± 8 years, 50% of women) were included; 157 (26.9%) had same-day PPI (SDP), and 427 (73.1%) were observed to assess for potential conduction recovery (n-SDP). In the n-SDP group, 376 patients (88%) finally received a PPI at a median of 3 [1-4] days following TAVR. There were no differences in periprocedural complications between groups, including pacemaker pocket hematomas, and the hospitalization length was shorter in the SDP group (5 [2-7] days vs 8[4-9] days; P < 0.001). At 1-month follow-up, the median percentage of ventricular pacing (SDP: 96% (22%-99%), n-SDP: 90% (10%-99%); P = 0.203) and pacemaker dependency rate (SDP: 56%, n-SDP: 50%; P = 0.277) were similar in both groups.
Conclusions:
In patients developing procedural persistent CHB/HAVB during TAVR, SDP was safe and associated with a shorter hospitalization length and a very high pacing burden at 30 days. These results, along with the very low rate of conduction recovery in the n-SDP group, would support SDP as a reasonable strategy in these patients.
