Impact of pre-existing conduction abnormalities on permanent pacemaker implantation after transcatheter aortic valve replacement: A meta-analysis

Table 2 Results of the systematic review

Ref.	Study design	Study location	Population characteristics	Intervention	Primary outcomes	Key findings
Muntané-Carol et al[18] (2021)	Prospective multicenter	Canada, United States	TAVR recipients without prior pacemaker	Minimalist TAVR with 14-day AECG monitoring	Occurrence of delayed HAVB or CHB	4.6% (21/459) developed delayed HAVB/CHB, leading to PPM in 81%
Pavlicek et al[19] (2023)	Prospective cohort	Germany	Severe AS; 54% male; mean age 80	TAVR with SEV (n = 103) or BEV (n = 100)	HAVB requiring PPM within 30 days	7% (15/203) required PPI; new LBBB (OR = 15.7) and diabetes (OR = 3.8) were predictors
Meduri et al[28] (2019)	RCT (REPRISE III)	United States, Germany	High/extreme surgical risk; mean age 83	Lotus mechanically-expanded vs CoreValve SEV	PPM within 30 days and dependency at 1 year	PPM higher with Lotus (34%) vs CoreValve (18%); dependency was 43% at 30 days
Castro-Mejía et al[36] (2022)	Retrospective multicenter	Spain	Severe AS; 39% male; median age 83	New-generation SEVs (Evolut, Acurate, Portico, Allegra)	Peri-procedural modification of AV conduction	17.7% required PPI; valve recapture (OR = 2.8) and depth (OR = 1.9) were predictors
Auffret et al[22] (2017)	Multicenter registry	Global (Canada, France, Spain, etc.)	AS candidates; 50% male; mean age 82	TAVR grouped by baseline RBBB	Cumulative all-cause mortality	Baseline RBBB in 10.3%; 30-day PPM in RBBB (40.1%) vs others (13.5%)
Bagur et al[23] (2012)	Case-matched cohort	Canada	Elderly AS; matched by baseline ECG	TAVI (Edwards) vs isolated SAVR	Complete AVB and PPM within 30 days	PPM higher in TAVI (7.3%) vs SAVR (3.4%); RBBB predicted TAVI PPM (OR = 8.6)
Wasim et al[30] (2025)	Prospective observational cohort	Norway	Severe AS; 50% male; mean age 80.6	TAVI (various valves) over low vs high volume phases	New PPM ≤ 30 days and all-cause death	31.6% total PPI rate; dropped from 45.8% to 23.9% with experience
Chen et al[25] (2024)	Registry analysis	United States, Canada	Intermediate/high risk PARTNER 2 S3 registries	TAVR with balloon-expandable SAPIEN 3	New PPM within 30 days	12.5% required PPI; RBBB (OR = 5.8) and depth > 6 mm (OR = 1.86) were predictors
Dizon et al[31] (2015)	RCT and registry analysis	United States, Canada	Inoperable/high-risk AS (PARTNER trial)	TAVI (Edwards SAPIEN)	1-year all-cause mortality	New PPM (6.8%) and prior PPM (22.9%) independently predicted mortality
Natarajan et al[37] (2022)	Prospective cohort	Canada	Outpatient AS; mean age 81.8	Routine 2-week pre/post rACM	Compliance to rACM and unplanned post-TAVI PPMI	15.6% total PPMI rate; 12.5% rACM notifications; unplanned PPMI only 3.1%
Fraccaro et al[33] (2011)	Registry analysis	Italy	AS due to calcification; mean age 81	TAVI with CoreValve system	Incidence/predictors of PPM	39% required PPI; predictors were depth (P = 0.039) and pre-existing RBBB (P = 0.046)
Guetta et al[20] (2011)	Registry analysis	Israel	AS Israeli registry; mean age 83	CoreValve TAVI	Development of HDAVB within 30 days	36% developed HDAVB (40% total PPM); RBBB (OR = 43) and depth (OR = 22) were predictors
Husser et al[38] (2016)	Prospective cohort	Germany, Switzerland	High-risk AS; mean age 80-81.	SAPIEN 3 (n = 96) vs SAPIEN XT (n = 87)	New IVCA and PPM implantation	PPM rate 12.5% (S3) vs 12.6% (XT); S3 had more fascicular blocks (17% vs 5%)
Khawaja et al[27] (2011)	Retrospective multicenter	United Kingdom, Ireland	United Kingdom CoreValve Collaborative; mean age 81.3	CoreValve TAVI	PPM within 30 days	33.3% required PPI; predictors included peri-pro AVB (OR 6.29) and predilatation (OR 2.68)
Kooistra et al[24] (2020)	Retrospective multicenter	Netherlands, Spain	Multi-center European registry; median age 82	TAVI (SEV vs BEV vs Other)	Timing of onset and predictors of late CDs	12% PPM rate; 18% of these were late (> 48 hours); IVCD (OR = 3.3) and RBBB (OR = 2.6) predict late PPM
Kostopoulou et al[32] (2015)	Randomized prospective	Greece	NYHA II/III AS; mean age 81	CoreValve TAVI with EPS vs ECG alone	Predictors of conduction abnormalities	22% PPM within 1 month; baseline HV interval (cut-off 52 ms) was prognostic
Ledwoch et al[34] (2013)	Prospective registry (GARY)	Germany	German GARY registry; mean age 81.5	TAVI (CoreValve vs Sapien)	Predictors of PPM up to 30 days	33.7% PPM rate; independent predictors: CoreValve (OR = 2.86), porcelain aorta (OR = 1.64)
Naveh et al[21] (2017)	Prospective observational	Israel	AS at Hadassah center; mean age 80.7	TAVI (CoreValve vs Sapien)	Predictors for long-term pacing dependency	34.5% total PPI; 68.4% dependent; RBBB (OR = 18) and delta PR > 28 ms were predictors
Rampat et al[26] (2017)	Retrospective multicenter	United Kingdom	United Kingdom LOTUS experience; mean age 81.2	LOTUS mechanically-expanded valve	PPM up to hospital discharge	31.8% PPM rate; 55.2% new LBBB; pre-procedural block composite (OR = 2.54) and absence of valve calcification (OR = 0.55) were independent predictors
Van Gils et al[29] (2018)	Prospective cohort (CONDUCT)	Netherlands	Rotterdam cohort; mean age 79	TAVI (various valves) with daily ECG monitoring.	QRS dynamics vs PPM requirement	23% PPM rate; only persistent QRS prolongation led to PPM in normal baseline patients

AS: Aortic stenosis; AV: Atrioventricular; AVB: Atrioventricular block; BEV: Balloon-expandable valve; CHB: Complete heart block; CD: Conduction disturbance; ECG: Electrocardiogram; EPS: Electrophysiology study; HAVB: High-degree atrioventricular block; HDAVB: High-degree atrioventricular block; HV: His-ventricular; IVCA: Intraventricular conduction abnormality; LBBB: Left bundle branch block; LOTUS: LOTUS Edge valve system; LVEF: Left ventricular ejection fraction; NYHA: New York Heart Association; OR: Odds ratio; PPM: Permanent pacemaker; PPI: Permanent pacemaker implantation; RBBB: Right bundle branch block; RCT: Randomized controlled trial; rACM: Remote ambulatory cardiac monitoring; SAVR: Surgical aortic valve replacement; SEV: Self-expanding valve; TAVI: Transcatheter aortic valve implantation; TAVR: Transcatheter aortic valve replacement.