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Recovering Intrinsic Conduction After TAVI: Can We Predict it?
Session:
Sessão de Posters 19 - Temas quentes em pacing e eletrofisiologia na era atual
Speaker:
Gonçalo Terleira Batista
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Gonçalo Terleira Batista; Mariana R. Simões; Ana Luisa Silva; Tatiana Pereira dos Santos; Tomas Carlos; Luisa Rocha; Bernardo Resende; Mafalda Grine; Didier Martinez; Ana Rita Ventura; Ana Vera Marinho; Lino Gonçalves
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Introduction:</span></strong><span style="color:black"> A significant proportion of patients undergoing TAVI require permanent pacemaker (PPM) implantation, yet many recover intrinsic conduction. Anticipating long-term pacing independence remains difficult as clinical and electrocardiographic markers offer limited predictive value.</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Aim:</span></strong><span style="color:black"> To characterize patients receiving PPM after TAVI and identify predictors of pacing independence at six months.</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> We analysed 176 patients who underwent TAVI between 2020 and 2024 and required PPM implantation within 14 days. Demographic, clinical and conduction-related parameters were collected. Between-group comparisons were performed using independent t-tests or Mann–Whitney U tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables. Variables with p < 0.05 entered a multivariable logistic regression model. Pacing dependency at six months was determined by device interrogation. Pacing percentages above 5% were considered indicative of dependency and values below 1% were classified as independent. Patients with pacing percentages between 1% and 4% were analysed individually and classified as dependent or independent after consensus review.</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Results:</span></strong><span style="color:black"> Patients requiring PPM had a mean age of 82.6 ± 5.2 years and 82.4% had hypertension 82.4%, 31.5% were diabetic and 26.1% had chronic kidney disease. Overall pacing implantation occurred in 18.5% of TAVI patients, and 23.5% of patients were non-dependent at six months. In bivariate analysis, most clinical characteristics and baseline conduction findings showed no association with pacing independence. A small number of parameters reached statistical significance, including atrial fibrillation prior to TAVI, paroxysmal versus persistent complete AV block after TAVI, QRS duration, and left ventricular ejection fraction. In multivariable logistic regression, paroxysmal complete AV block was the only independent predictor of pacing independence at one year (OR 3.80; 95% CI 1.48–9.76; p = 0.005).</span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="color:black">Conclusion:</span></strong><span style="color:black"> Predict pacing independence following PPM implantation after TAVI is still a challenge. Paroxysmal complete AV block was the only independent marker associated with recovery of intrinsic conduction, suggesting that in selected patients a short observation period may help avoid unnecessary long-term pacing. However, these findings also highlight the importance of accurately defining pacing dependency itself. Further prospective studies are needed to validate these results and refine risk stratification and dependency definitions in this population.</span></span></span></span></p>
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