Incidence and Predictors of Permanent Pacemaker Implantation After Balloon‐Expandable TAVI: Applicability of the RITMO Score

BACKGROUND: Permanent pacemaker implantation (PPMI) remains a common complication after transcatheter aortic valve implantation (TAVI). While the RITMO score-incorporating right bundle branch block (RBBB), membranous septum length (MSL), and aortic valve calcium load-was developed for self-expanding valves, its performance in balloon-expandable valves (BEVs) is uncertain. AIMS: To evaluate the incidence and predictors of PPMI following balloon-expandable TAVI and to assess the applicability of the RITMO score in this valve platform. MATERIALS AND METHODS: We retrospectively analyzed 310 patients who underwent TAVI with balloon-expandable Edwards Sapien valves. Baseline clinical, electrocardiographic, and MSCT data were collected, and the RITMO score was calculated for all. Independent predictors were identified using multivariable logistic regression. RESULTS: PPMI occurred in 34 patients (10.9%). Compared with the non-PPMI group, those requiring PPMI had significantly higher rates of baseline RBBB (p < 0.001), shorter MSL (p = 0.002), and elevated Agatston calcium scores (p = 0.001). In multivariable analysis, RBBB (p < 0.001), short MSL (p = 0.002), and high Agatston score (p = 0.009) were independent predictors. Patients in the RITMO high-risk category (> 1) had a 12.3-fold higher likelihood of requiring PPMI compared with the low-risk group (OR: 12.3, 95% CI: 5.6-27.3). The RITMO score demonstrated strong discriminatory performance (AUC: 0.839, 95% CI: 0.769-0.909, p < 0.001). CONCLUSIONS: The RITMO score is a valid and effective tool for predicting PPMI after BEV-TAVI. Its simplicity and applicability support its use in procedural planning and early risk stratification, independent of valve type.