Permanent Pacemaker Implantation After TAVI and Its Association with Survival: Single-Center Cohort and Nationwide Validation

Background: Permanent pacemaker (PM) implantation is a well-recognized complication of transcatheter aortic valve implantation (TAVI), but its long-term prognostic impact remains uncertain. Objective: To evaluate the association between PM implantation and all-cause mortality in TAVI recipients.Methods: We performed a post-hoc analysis of a prospective single-center TAVI registry (2016–2020). The primary endpoint was all-cause mortality at 1 and 5 years. Cox regression and Kaplan–Meier analyses were applied. Validation using the nationwide AUTHEARTVISIT claims database was performed.Results: Among 1114 consecutive TAVI patients (mean age 81 ± 5.8 years; 49.8% female), 120 (10.8%) had a pre-existing PM (Pre-PM), and 153 (13.7%) received a new PM within 30 days post-TAVI (Post-PM). Post-PM patients were older (p=0.006), more often male (p<0.001), had higher Troponin T levels (p=0.002), more pre-existing right bundle branch block (p<0.001) and longer QRS duration (p<0.001) compared to patients without PM. On multivariate analysis, one-year mortality was associated with Troponin T (p=0.002) and NT-proBNP (p=0.002) serum levels. Pre-and Post-PM status was not associated with 1-year mortality (p=0.455, p=975). However, Pre-PM was independently associated with 5-year mortality (HR 1.4, 95% CI: 1.0–1.9, p=0.03), whereas Post-PM was not (HR 1.2, 95% CI: 0.8–1.6, p=0.22). Findings were confirmed in the nationwide AUTHEARTVISIT cohort. Conclusion: In this large, real-world TAVI cohort with national validation, Post-PM status was not associated with mortality at 1 or 5 years. In contrast, Pre-PM identified patients at higher long-term risk, possibly reflecting underlying cardiac disease.