Fuchs TK, Jones C, Patterson JB. Impact of pre-existing conduction abnormalities on permanent pacemaker implantation after transcatheter aortic valve replacement: A meta-analysis. World J Cardiol 2026; 18(8): 123559 [DOI: 10.4330/wjc.123559]
Corresponding Author of This Article
Tobias K Fuchs, Doctorate Student, Researcher, Department of Clinical Sciences, Edward Via College of Osteopathic Medicine-Virginia Campus, 2265 Kraft Drive, Blacksburg, Virginia 24060, United States. tfuchs@vcom.edu
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Cardiac & Cardiovascular Systems
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research-article
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Fuchs TK, Jones C, Patterson JB. Impact of pre-existing conduction abnormalities on permanent pacemaker implantation after transcatheter aortic valve replacement: A meta-analysis. World J Cardiol 2026; 18(8): 123559 [DOI: 10.4330/wjc.123559]
World J Cardiol. Aug 26, 2026; 18(8): 123559 Published online Aug 26, 2026. doi: 10.4330/wjc.123559
Impact of pre-existing conduction abnormalities on permanent pacemaker implantation after transcatheter aortic valve replacement: A meta-analysis
Tobias K Fuchs, Cameron Jones, John B Patterson
Tobias K Fuchs, Cameron Jones, Department of Clinical Sciences, Edward Via College of Osteopathic Medicine-Virginia Campus, Blacksburg, VA 24060, United States
John B Patterson, Division of Cardiology, Lewis Gale Physicians, HCA Virginia Health System, Blacksburg, VA 24060, United States
Author contributions: Fuchs TK, Jones C, and Patterson JB designed the study and contributed to its conception, revised the manuscript critically for important intellectual content and approved the final version for submission; Fuchs TK and Jones C performed the literature search, study screening, data extraction, and statistical analysis; Fuchs TK drafted the manuscript; Patterson JB provided supervision; all authors have read and approved the final manuscript.
AI contribution statement: AI tools (specifically OpenAI’s ChatGPT) were used solely for language editing, manuscript organization, and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors. The authors assume full responsibility for the integrity, accuracy, originality, and scientific validity of all submitted materials.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Tobias K Fuchs, Doctorate Student, Researcher, Department of Clinical Sciences, Edward Via College of Osteopathic Medicine-Virginia Campus, 2265 Kraft Drive, Blacksburg, Virginia 24060, United States. tfuchs@vcom.edu
Received: May 22, 2026 Revised: July 5, 2026 Accepted: August 20, 2026 Published online: August 26, 2026 Processing time: 97 Days and 2.5 Hours
Abstract
BACKGROUND
Transcatheter aortic valve replacement (TAVR) has become the standard treatment for severe aortic stenosis, but permanent pacemaker implantation (PPI) remains a frequent complication. Despite several predictive models and single-center cohorts, prediction algorithms remain poor.
AIM
To synthesize evidence on baseline conduction abnormalities and their association with PPI after TAVR.
METHODS
We conducted a systematic review and meta-analysis in accordance with PRISMA 2009 guidelines. We searched PubMed, Cochrane, and EMBASE for papers published between January 2010 and February 2026. Adults (> 18 years) having TAVR with documented baseline electrocardiographic status and post-procedural pacemaker outcomes were considered eligible for inclusion. The pooled proportions and odds ratios were estimated using random effects models. Heterogeneity was evaluated using I2 statistics.
RESULTS
Twenty studies comprising 15515 patients were included. The pooled incidence of new PPI was 18% (95%CI: 0.14-0.24). New-onset left bundle branch block (LBBB) occurred in a pooled proportion of 38% of patients (95%CI: 0.27-0.50) across 11 studies. New-onset RBBB was reported separately from new-onset LBBB in only two cohorts and could not be pooled. Pre-existing RBBB was the strongest predictor of pacemaker requirement, conferring a 4.52-fold increased risk (95%CI: 2.64-7.74), with moderate heterogeneity (I2 = 50.3%). Left ventricular ejection fraction showed inconsistent associations with pacemaker needs.
CONCLUSION
Baseline RBBB in particular demonstrated a strong and consistent association with PPI. These findings should inform preprocedural risk stratification, patient counseling, procedural planning, and enhanced postprocedural monitoring strategies for high-risk patients.
Core Tip: Baseline right bundle branch block is associated with a 4.52-fold increased odds of permanent pacemaker implantation after transcatheter aortic valve replacement (95%CI: 2.64-7.74; I2 = 50.3%), underscoring the clinical relevance of preprocedural electrocardiographic risk stratification in this population.
