Permanent pacemaker implantation (PPI) within 30 days of transcatheter aortic valve replacement (TAVR) is a common complication that challenges post-procedural care. A systematic review and meta-analysis published in The American Journal of Cardiology analyzed 108 studies with 77,538 patients, of whom 14,560 required PPI, to clarify the strongest risk factors.

Conduction abnormalities were the strongest signals. Third-degree atrioventricular block (AVB) carried the highest risk (risk ratio [RR] 13.46), followed by Mobitz I (RR 5.16), Mobitz II (RR 2.30), and intraprocedural AVB (RR 4.15). Other significant predictors included right bundle branch block (RR 3.20), bifascicular block (RR 2.34), left posterior hemiblock (RR 2.57), and left anterior hemiblock (RR 1.79). Male sex (RR 1.13) and baseline atrial fibrillation (RR 1.12) also contributed.

Procedural features influenced risk. Self-expandable valves (RR 1.79), subclavian access (RR 1.75), and 29 mm prostheses (RR 1.33) were associated with higher PPI rates compared with balloon-expandable valves, transfemoral access, and 23 mm prostheses. Predictors were ranked using surface under the cumulative ranking curve (SUCRA) values, with third-degree AVB (<0.01) most influential, followed by Mobitz I, Mobitz II, intraprocedural AVB, bifascicular block, right bundle branch block, and left posterior hemiblock.