Patients implanted with a leadless pacemaker after transcatheter aortic valve implantation: Results from the MITAVI prospective study - 22/04/26

Doi : 10.1016/j.acvd.2026.02.004

Nicolas Lellouche ^a,⁎ , Eloi Marijon ^b, Vincent Algalarrondo ^c, Romain Gallet ^a, Madjid Boukantar ^a, Tarvinder Dhanjal ^d, Thibaut Moulin ^a, Marina Urena ^c, Chekrallah Chamandi ^b, Jean-Philippe Collet ^e, Estelle Gandjbakhch ^e, Emmanuel Teiger ^a

^a Cardiology Division, Henri-Mondor University Hospital, AP–HP, 51, avenue du Maréchal-de-Lattre de Tassigny, 94000 Créteil, France

^b Cardiology Division, Georges-Pompidou European Hospital, AP–HP, 75015 Paris, France

^c Cardiology Division, Bichat Hospital, AP–HP, 75018 Paris, France

^d Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, CV2 2DX Coventry, United Kingdom

^e Cardiology Division, Pitié-Salpêtrière Hospital, AP–HP, 75013 Paris, France

^⁎ Corresponding author: Henri-Mondor University Hospital, AP–HP, 51, avenue du Maréchal-de-Lattre de Tassigny, 94000 Créteil, France. Henri-Mondor University Hospital, AP–HP 51, avenue du Maréchal-de-Lattre de Tassigny Créteil 94000 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 22 April 2026

Graphical abstract

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Highlights

•	Prospective cohort of 102 patients undergoing TAVI and LPM implantation.
•	Low rate of complications and excellent electrical variables at 1-year follow-up.
•	32 patients had LPM implantation immediately after TAVI, during the same procedure.
•	These patients had no electrical conduction recovery at one year.
•	At 1-year follow-up, the all-cause death and HF hospitalization rates were 12%.
•	At 1-year follow-up, there was no significant decrease in LVEF.
•	The need for an upgrade to a transvenous pacemaker was low (< 1%).

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Transcatheter aortic valve implantation is a well-established clinical procedure for treating severe aortic stenosis. High-grade atrioventricular block has been reported in 10–30% of patients following transcatheter aortic valve implantation. Traditional transvenous pacemakers are associated with several potential complications, including endocarditis, lead dislodgement or fracture, pocket haematoma and tricuspid regurgitation. These risks may be mitigated with the use of leadless pacemakers.

Aim

We proposed to evaluate the 1-year clinical and electrical outcomes of patients implanted with a leadless pacemaker following transcatheter aortic valve implantation.

Methods

From July 2019 to December 2022, 102 patients from four French centres who underwent transcatheter aortic valve implantation and subsequently required pacemaker implantation with a leadless pacemaker (Micra; Medtronic, Dublin, Ireland) were evaluated prospectively.

Results

The mean patient age was 82 ± 9 years, and the mean baseline left ventricular ejection fraction was 58.4 ± 10.6%. Major complications included one case of cardiac tamponade and one case of device migration. During 12-month follow-up, one patient required transvenous cardiac resynchronization therapy pacing because of severe heart failure. The all-cause death rate was 12%, and the heart failure hospitalization rate was also 12%. Compared with baseline, leadless pacemaker electrical variables improved at 1 year. Additionally, complete atrioventricular conduction restoration was observed in 38% of the cohort.

Conclusions

Leadless pacemakers can be implanted in patients following transcatheter aortic valve implantation, with low complication rates and excellent electrical variables at 1-year follow-up. The need for an upgrade to a transvenous pacemaker was low (< 1%).

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Keywords : Transcatheter aortic valve implantation, Leadless pacemaker, Micra, Atrioventricular block