Junctional Rhythms After Transcatheter Aortic Valve Implantation: Incidence, Temporal Patterns, and Clinical Outcomes

Conduction disturbances are common after transcatheter aortic valve implantation (TAVI), yet the clinical implications of junctional rhythm (JR) remain poorly characterized. We aimed to assess the incidence, temporal characteristics, and clinical outcomes associated with JR occurring after TAVI.

We conducted a prospective study including all TAVI patients at Clermont-Ferrand University Hospital between December 2023 and April 2025. Patients who developed JR were identified, and a propensity score was used to match them in a 1:3 ratio with patients without JR.

Among 616 TAVI procedures, JR was identified in 26 patients (4.2%). The mean time to onset was 41 ± 22 hours after TAVI, with a mean junctional rate of 71 ± 12 beats per minute. At baseline, no significant differences were present in clinical, electrocardiographic, or procedural characteristics between patients with vs without JR. The incidence of in-hospital high-grade atrioventricular block did not differ significantly between groups (11.5% vs 10.3%, P = 0.48). Permanent pacemaker implantation occurred in 38.5% of JR patients (10 of 26) vs 16.7% of controls (13 of 78; P = 0.02). JR was consistently asymptomatic and transient, and its morphology suggested either Hisian or infra-Hisian origin.

JR after TAVI appeared to be an infrequent and transient phenomenon. Although pacemaker implantation was more frequent among JR patients, no excess of documented high-grade atrioventricular block was observed. The higher pacemaker rate appeared to be related primarily to precautionary management decisions. These findings require confirmation in larger multicentre cohorts.