Permanent Pacemaker Dependency after Transcatheter Aortic Valve Implantation (TAVI): Comparison of Self-Expanding and Balloon-Expandable Prostheses

All articles of this category (opens in new window) Background: Conduction disturbances requiring permanent pacemaker implantation (PPI) are frequent after transcatheter aortic valve implantation (TAVI) and represent a continued concern. The extent of mid-term pacemaker dependency and pacing burden remains unclear. Methods: This retrospective, single-center study included 2.630 consecutive patients receiving TAVI between 2016 and 2022. A total of 281 patients (self-expanding valve [SEV] n = 162; balloon-expandable valve [BEV] n = 119) who required new pacemaker implantation following TAVI underwent rhythm analysis. The cohort was analyzed for atrial fibrillation (AF), complete right bundle branch block (RBBB), first-degree AV block (AV I degrees), and postdilatation. Mid-term conduction disturbances and pacing burden after self-expanding (SEV) and balloon-expandable valves (BEV) were assessed for comparative analysis. Results: Preinterventional rhythm disturbances at baseline were distributed as follows for SEV vs. BEV: AF 43.8% vs. 47.1% ( p = .591), RBBB 24.1% vs. 0.0% ( p < .001), AV I degrees 16.0% vs. 1.7% ( p < .001). Postdilatation was more common in SEV (21.3% vs. 6.0%; p < .001). Postimplant high-degree AV block occurred in 24.6% after SEV and 9.6% after BEV ( p = .039). PPI was required more often after SEV (12%) than after BEV (9.1%). Combined mean pacing burden decreased from 80.4% early to 48.0% by 12 months. Values stratified by SEV/BEV were as follows: 83.1%/77.6%, 61.7%/62.8%, 56.0%/48.7%, 45.6%/50.8% at 0 to 14/30 to 50/120 to 150, and 330 to 400 days. Conclusion: AF, RBBB, AV I degrees, and postdilatation are frequent in patients at risk for conduction disturbances after TAVI and may guide early PPI decisions, but their association with mid-term pacing dependency appears coincidental, as pacing burden declined to 48.0% by 12 months. Pacing burden reduction was similar between valve types, reflecting parallel mid-term AV-conduction recovery. Further analyses are needed to predict true pacing burden at follow-up. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany