Transcatheter Aortic Valve Implantation and Requirements of Pacing Over Time EUL ´ ALIA PEREIRA, M.D.,* NUNO FERREIRA, M.D.,* DANIEL CAEIRO, M.D.,* JO ˜ AO PRIMO, M.D.,* LU ´ IS AD ˜ AO, M.D.,* MARCO OLIVEIRA, M.D.,* HELENA GONC ¸ALVES, M.D.,* JOS ´ E RIBEIRO, C.C.V.T.,* ELISABETH SANTOS, C.C.V.T.,* DANIEL LEITE, R.T.,* NUNO BETTENCOURT, M.D.,* PEDRO BRAGA, M.D.,* LINO SIM ˜ OES, M.D.,* LU ´ IS VOUGA, M.D.,† and VASCO GAMA, M.D.* From the *Department of Cardiology; and †Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal Background: A permanent pacemaker (PPM) implantation is common after transcatheter aortic valve implantation (TAVI). We sought to evaluate requirements of pacing and incidence of pacemaker dependency during the first year after TAVI. Methods: From August 2007 until May 2011, 65 patients underwent TAVI with self-expandable prosthesis. Five patients paced at baseline and two procedure-related deaths were excluded. Evaluation of ventricular pacing percentage (VP%) and look for spontaneous rhythm were performed at 3, 6, and 12 months. Results: PPM implantation was required in 19/58 patients (33%). Mean VP% decreased between assessments (59% at 3 months, 48% at 6 months, 50% at 12 months), but overall VP% at 1 year was high (57% ± 43%) and most patients were paced ≥10% of time. A favorable annulus-to-aorta angle was associated with lower pacing requirements (60% of patients paced ≤10% of time vs 10% of patients paced >10% of time presented an angle ≤30 0 ,P = 0.039). Pacemaker dependency was established in 27% of patients and could be predicted by the presence of porcelain aorta (odds ratio = 30, confidence interval 95% 1–638, P = 0.029). New postprocedural left bundle branch block (LBBB) had a negative impact on 1-year survival (58% vs 82% in non-LBBB group, P = 0.111). PPM implantation had no impact on 1-year survival. Conclusions: One third of patients required PPM after TAVI and full recovery of advanced conduction abnormalities seems unlikely. Unfavorable aortic root orientation may hinder the deployment of the valve and contribute to the continued impairment of the conduction system. Porcelain aorta was a strong predictor of pacemaker dependency. (PACE 2013; 36:559–569) aortic stenosis, transcatheter aortic valve implantation, permanent pacemaker, pacemaker dependency Introduction Transcatheter aortic valve implantation (TAVI) is an established treatment for inoperable patients with severe aortic stenosis (AS) and an alternative therapeutic approach for high-risk patients 1 with an all-cause mortality at 1 year similar to surgical aortic valve replacement (AVR) according to the Partner A Trial (27% for AVR vs 24% for TAVI, P = 0.62). 2 However, TAVI-related Conflicts of interest: The authors have no potential conflicts of interest and no financial support. Address for reprints: Eul´ alia Pereira, M.D., Rua Conceic ¸˜ ao Fernandes, 4434–502 Vila Nova de Gaia, Portugal. Fax: 351 227830209; e-mail: eulaliaalvespereira@gmail.com Received September 14, 2012; revised November 26, 2012; accepted December 28, 2012. doi: 10.1111/pace.12104 conduction disturbances and need of permanent pacemaker (PPM) implantation remain a point of concern, mainly with the Medtronic CoreValve system (Medtronic Inc., Minneapolis, MN, USA) with reported rates systematically above 9% to 10%, but up to 40% in some series. 3 Several factors have been reported to pre- dict the need of PPM implantation after TAVI including preexisting bundle branch block, larger stent size, postdilatation, deep valve implantation, increased septal wall thickness, noncoronary cusp thickness, and degree of calcification. 4–6 Previous studies suggest that some conduction disturbances may resolve following TAVI, 5,7–9 but evidence is scarce regarding the exact requirements of pacing over time in permanent pacemaker patients. The main purpose of our study was to examine the requirements of pacing and the incidence of pacemaker dependency during the ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc. PACE, Vol. 36 May 2013 559