Prognostic Impact of Pacemaker Implantation in Transcatheter Aortic Valve Replacement With Self-Expanding Prosthesis

Catheter Cardiovasc Interv. 2026 Aug;108(2):314-322. doi: 10.1002/ccd.70652. Epub 2026 May 12.

Abstract

Background: With the progressively increasing number of low-risk patients undergoing transcatheter aortic valve replacement (TAVR), the number of those who will be long-time pacemaker (PM) carriers is expected to increase. To date, conflicting data is available regarding the association between PM and mortality following TAVR.

Aims: To investigate the association between PM and mortality in patients undergoing TAVR with self-expandable bio-prosthesis.

Methods: Patients undergoing TAVR between 2007 and 2014 in 10 Italian centers were considered. Two analyses were performed: one comparing patients with and without pre-TAVR PM (primary) and one comparing those with and without post-TAVR PM (secondary). The primary endpoint was all-cause mortality; the secondary endpoint was re-hospitalization to the cardiac ward. Clinical outcomes were assessed at the longest available follow-up.

Results: Overall, 1779 patients were included in the primary analysis and 1465 in the secondary one. Pre-TAVR PM implantation was not associated with an increased risk of all cause death in both the primary (adj. HR 0.93, 95% CI 0.76-1.13; p = 0.475) and secondary analysis (adj. HR 0.83, 95% CI 0.71-0.98; p = 0.029). Regarding hospitalization to cardiac ward, pre-TAVR PM was not associated with the outcome (adj. HR 1.10, 95% CI 0.85-1.42, p = 0.254), while post-TAVR PM implantation was related with an increased risk (adj. HR 1.94, 95% CI 1.56-2.41; p < 0.001).

Conclusions: PM implantation is not associated with an increased risk of mortality in patients undergoing TAVR.

Keywords: TAVR; mortality; pacemaker.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis* / diagnostic imaging
  • Aortic Valve Stenosis* / mortality
  • Aortic Valve Stenosis* / physiopathology
  • Aortic Valve Stenosis* / surgery
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Aortic Valve* / surgery
  • Arrhythmias, Cardiac* / diagnosis
  • Arrhythmias, Cardiac* / mortality
  • Arrhythmias, Cardiac* / physiopathology
  • Arrhythmias, Cardiac* / therapy
  • Bioprosthesis*
  • Cardiac Pacing, Artificial* / adverse effects
  • Cardiac Pacing, Artificial* / mortality
  • Female
  • Heart Valve Prosthesis*
  • Humans
  • Italy
  • Male
  • Pacemaker, Artificial*
  • Patient Readmission
  • Prosthesis Design
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Transcatheter Aortic Valve Replacement* / mortality
  • Treatment Outcome