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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
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Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Incidence, Predictors, and
Omar Saleh1, Nicholas J Valle1, Shinjer Li2
1Department of Internal Medicine, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Summary
Permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) is not linked to higher mortality or major adverse cardiovascular events. However, PPM is associated with a significantly reduced risk of ischemic stroke within one year post-TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Conduction abnormalities are common after transcatheter aortic valve replacement (TAVR).
- The impact of permanent pacemaker (PPM) implantation post-TAVR on clinical outcomes, including stroke, requires further clarification.
Purpose of the Study:
- To assess the incidence and predictors of PPM implantation following TAVR.
- To evaluate the association between post-TAVR PPM and 1-year outcomes, specifically mortality, major adverse cardiovascular events (MACE), and ischemic stroke risk.
Main Methods:
- Retrospective analysis of 1101 adult patients undergoing TAVR between 2008-2019.
- Exclusion of patients with prior PPM or repeat/valve-in-valve TAVR.
- Primary outcomes included 1-year mortality, MACE, myocardial infarction, and ischemic stroke, analyzed using multivariate logistic regression.
Main Results:
- 14.4% of TAVR patients received PPM within 1 year; 12.3% in-hospital, 2.1% post-discharge.
- PPM was not associated with significant differences in 1-year mortality or MACE.
- PPM was independently associated with a 77% lower risk of 1-year ischemic stroke (adjusted OR 0.234).
- Late PPM implantation (>3 days) showed a trend toward worse outcomes but did not reach statistical significance.
Conclusions:
- Post-TAVR PPM is not associated with increased mortality or MACE.
- PPM implantation after TAVR is independently linked to a significantly lower risk of ischemic stroke.
- Early PPM implantation, when indicated, may be preferable and potentially offers cerebrovascular protection, warranting further investigation.
