Transcatheter Aortic Valve Implantation (TAVI) is associated with worsening of present AV conduction defects and the appearance of new ones, with a consequent need for permanent pacemaker (PPM) implantation in up to 40% of patients. AV conduction defects and the need for PPM after TAVI may be associated with procedural complications. We hypothesized that the existence of a PPM prior to TAVI may improve procedural outcomes. Methods and Results: 166 consecutive TAVI patients were treated in a single center and included in this study. Demographic, clinical, procedure-related and post-procedural variables were included in our analysis. Patients were divided into three groups: no PPM, existing PPM or post-TAVI PPM. Patients in the existing PPM group were slightly older than the other groups (80.9 yrs vs. 80.5) with a higher logistic Euroscore, 2.3 ± 16.73% compared with 20.1±16.31% in the no PPM group and 23.1±16.17% in the post-TAVI PPM group (p0.05 for both). Despite a higher predicted pre-procedural risk, existing PPM patients had a lower rate of bleeding (48.1% vs. 54%, p=0.07) and especially major (14.8% vs. 18%p=0.07) and life-threatening (3.7% vs. 12.2%, p=0.13) bleeding events when compared with the other two groups combined. Tamponade did not occur in the existing PPM group while occurring 11 times (7.9%) in the other patients. In 9 cases tamponade was related to the peri-procedural temporary pacemaker electrode. The length of hospital stay was shorter in the existing PPM when compared with the two other groups combined, 5.95±3.75 days vs. 7.91±5.21 days, respectively ( p=0.06). Discussion: TAVI patients with a previously implanted PPM have lower rates of bleeding and tamponade and a reduced length of hospital stay despite a higher predicted pre-procedural risk. Existing PPM during TAVI can be considered protective as the acute development of AV conduction defects in the post TAVI setting may be complicated by hemodynamic instability. Furthermore, patients with no PPM require placement of a temporary pacemaker lead which may be associated with tamponade.
