Incidence, Predictors and Prognosis of Pacemaker Implantation after Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: A Prospective Cohort Study

Abstract

Background: Cardiac conduction disturbances remain a frequent complication after aortic valve replacement, particularly following transcatheter aortic valve implantation. These disturbances may necessitate permanent pacemaker implantation and can influence post procedural outcomes, yet comparative prospective data integrating anatomical predictors remain limited.

Aim: To compare the incidence and prognosis of cardiac conduction disturbances and permanent pacemaker implantation after transcatheter versus surgical aortic valve replacement, and to identify independent clinical and radiological predictors of pacemaker requirement.

Method: This prospective cohort study included 60 elderly patients with severe aortic stenosis who underwent either surgical aortic valve replacement or transcatheter aortic valve implantation. Clinical, electrocardiographic, echocardiographic, and computed tomography based radiological data were collected. Patients were followed for six months to assess new onset conduction disturbances, pacemaker implantation, and clinical outcomes. Multivariable regression analysis was used to identify independent predictors of permanent pacemaker implantation.

Results: Among 60 patients, 20 underwent SAVR and 40 underwent TAVI. New onset conduction disturbances were more frequent after TAVI than SAVR (45% vs 15%). Permanent pacemaker implantation occurred in 35% of TAVI patients compared with 10% after SAVR. Within TAVI, pacemaker implantation was higher with self-expandable valves than balloon expandable valves (50% vs 20%). Greater implantation depth and higher LVOT calcification were independent predictors of pacemaker implantation.

Conclusion: Transcatheter aortic valve implantation is associated with a higher risk of conduction disturbances and permanent pacemaker implantation than surgical replacement, driven largely by procedural and anatomical factors. Integration of detailed pre procedural imaging may improve risk stratification and procedural planning.

Keywords: Aortic stenosis; Transcatheter aortic valve implantation; Surgical aortic valve replacement; Conduction disturbances; Permanent pacemaker implantation; Computed tomography; Implantation depth; Left ventricular outflow tract; Valve type; Prognosis.