Reevaluation of the Indications for Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

By Julie Bjerre Thygesen

Transcatheter aortic valve implantation (TAVI) has during the past 10 years developed into a treatment for patients with severe aortic stenosis who are considered at high or extreme surgical risk. Since TAVI may expand into intermediate or even low-risk patients in the near future, it seems important to keep evaluating the complications and explore possible ways to minimize these. TAVI with self-expanding frames is associated with a high incidence of conduction disturbances and need for permanent pacemaker (PPM). The background for performing this study was a hypothesis that after TAVI, the indication for PPM is set too early and a “wait-and-see” approach may reduce the need for PPM.

Our study in this month’s Journal of Invasive Cardiology shows that the conduction system is affected by prolongation of both the PR and QRS interval in the first 9 days after the TAVI. This is often the time period where the indication for PPM is being set. Half of the patients who had received a PPM within the first 30 days after TAVI had no indication for the PPM after the periprocedural period. The results indicate that a “wait-and-see” approach may lower the rate of PPM after TAVI, but must also be seen in relation to the cost of prolonged hospital stay and possible complications to a temporary wire.


A selection of recent Pacemaker-Related Articles available at


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