A computed tomography–based conduction pathway simulation tool may help guide implantation depth during transcatheter aortic valve implantation. The study, published in Heart Rhythm, examined whether patient-specific conduction mapping could reduce the need for permanent pacemaker implantation.

The analysis evaluated 228 adults with a median age of 82 years, among whom 57% were women. Overall, 22.4% required a pacemaker after the procedure. Mapping showed that the His bundle, conduction tract midpoint, and left bundle branch origin lay approximately 5.3 mm, 3.9 mm, and 2.5 mm below the annulus. Implantation below these structures significantly increased pacemaker risk, with odds rising about 25% per millimeter.

A small subgroup of 25 patients received implantation above their individualized conduction pathway and experienced no pacemaker events, compared with rates between 17.4% and 25.0% when valves were implanted 1–4 mm below the annulus.

These findings indicate that CT-derived conduction mapping may support tailored implantation strategies to limit conduction injury. Prospective studies are required to determine whether this approach can be integrated into routine TAVI planning