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Updated: Jan 17, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Prophylactic Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement.

Quentin Fischer1, Luis Nombela-Franco2, Guillem Muntané-Carol3

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

JACC. Clinical Electrophysiology
|September 18, 2025
PubMed
Summary
This summary is machine-generated.

Prophylactic permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) is indicated in about a quarter of patients. While clinical outcomes are similar, prophylactic PPI significantly reduces pacing burden, questioning its systematic use.

Keywords:
conduction disturbancesleft bundle branch blockpermanent pacemakersudden cardiac deathtranscatheter aortic valve implantation

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Management of new conduction disturbances post-transcatheter aortic valve replacement (TAVR) is debated.
  • Transcatheter aortic valve replacement (TAVR) is increasingly common, leading to potential conduction issues.

Purpose of the Study:

  • To evaluate the incidence of prophylactic permanent pacemaker implantation (PPI) after TAVR.
  • To assess the clinical impact and pacing burden associated with prophylactic PPI post-TAVR.

Main Methods:

  • Subanalysis of the prospective multicenter PROMOTE trial (NCT04139616).
  • Included 2,110 patients undergoing TAVR without prior pacemakers.
  • Defined prophylactic PPI criteria based on QRS and PR intervals and electrocardiogram changes.

Main Results:

  • 24.3% of patients receiving PPI post-TAVR had a prophylactic indication, mainly for left bundle branch block.
  • 30-day clinical outcomes were similar between prophylactic and non-prophylactic PPI groups.
  • Prophylactic PPI significantly reduced ventricular pacing percentage (2% vs 73%) at 30 days.

Conclusions:

  • Approximately one-fourth of PPIs post-TAVR were prophylactic.
  • Prophylactic PPI demonstrated a very low pacing burden at 30 days.
  • Findings suggest reconsidering the routine use of prophylactic PPI after TAVR.