Pacing Ratio Changes of an Implanted Permanent Pacemaker After Transcatheter Aortic Valve Implantation

In some patients, transcatheter aortic valve implantation (TAVI) is associated with conduction disturbances, necessitating permanent pacemaker implantation (PMI). The clinical course of conduction disturbances after PMI, based on the type of TAVI valve, remains unclear. Therefore, the present study aimed to evaluate the effects of different types of TAVI valves on the clinical course of conduction disturbances.

In total, 480 patients, including 230 with self-expandable (SE) valves and 250 with balloon-expandable (BE) valves, who underwent TAVI between January 2016 and December 2024, were enrolled in this study. The characteristics of patients who required PMI and the changes in the ventricular pacing ratio were compared.

There was no significant difference in PMI factors depending on the type of valve. Computed tomography (CT) images showed that the length of the membranous septum (MS) in the PMI group did not differ from the length of the MS in the non-PMI group. There was a significant difference in improvement in autologous AV conduction between the SE and BE groups at PMI time (SE group vs. BE group; 11/15 [66.7%] vs. 3/11 [27.3%], p = 0.047). At 1 month follow-up, the SE group improved significantly compared to the BE group (SE vs. BE; 14/15 [93.3%] vs. 4/11 [33.3%], p = 0.002).

Restoration of autologous AV conduction and subsequent decrease in ventricular pacing ratio were more likely in the SE group and less variable in the BE group. This result indicates that PM dependency can be reduced by using an extended AVD setting or AVH.