Atrioventricular block is a common complication in patients undergoing transcatheter aortic valve implantation (TAVI). The safety and efficacy of leadless pacemaker (L-PM) have been demonstrated in multiple clinical trials, but real-world data on L-PM after TAVI are still lacking.

The aim of the current study was to compare safety and efficacy of L-PM versus conventional transvenous pacemaker (T-PM) after a TAVI procedure.

In this single center study, consecutive patients undergoing T-PM vs. L-PM after TAVI were included between January 2019 and March 2023. Data were collected retrospectively.

A total of 100 consecutive patients were included. 53 undergoing T-PM implantation (40 dual chamber; 13 single chamber PMs) and 47 undergoing a L-PM implantation (Fig. 1). Baseline characteristics were not significantly different in both groups (Table 1). Leading indication for ventricular pacing was complete AV block (78% of pts).

Duration of hospitalization were significantly shorter in the L-PM group in multivariable analysis (–1.54 [–2.57; –0.789] P<0,01).

Complications within 30 days were significantly higher in the T-PM group (2 complications occurred in the L-PM group vs. 11 in the T-PM group; P=0,02). We observed two complications in the L-PM group: one patient had a loss of function of the leadless device and require the implantation of a conventional T-PM, one another presented an arteriovenous fistula. There were 11 complications in the group conventional pacemaker including 3 infective endocarditis and two pneumothorax. No pericardial effusions, no death related to the pacemaker were observed in both groups.

Pacing threshold was significantly higher in the T-PM group vs. the L-PM group (0.5 (0.5;0.725) V 0.4ms vs. 0.38 (0.250; 0.690) V 0.24ms).

Patients referred for TAVI are typically of advanced age and have multiple comorbidities. The implantation of leadless PM following TAVI may have fewer complications and it may therefore be a reasonable option for TAVI patients.