Need for a permanent pacemaker after transcatheter aortic valve implantation in Spain: a retrospective analysis of the national Minimum Basic Dataset from 2017 to 2022.

Background: There is no available information on the risk of permanent pacemaker implantation following transcatheter aortic valve implantation (TAVI) in Spain. Our objective was to investigate the incidence, temporal trends, and factors associated with this complication between 2017 and 2022, using data from the Spanish National Hospital Discharge Database (CMBD).

Methods: This retrospective study was based on CMBD data of patients who underwent TAVI between 2017 and 2022. Patients under 60 years of age and those with a prior pacemaker or valve prosthesis were excluded. Demographic variables, comorbidities, hospital procedural volume and pacemaker incidence were analysed. A multivariable analysis was performed to evaluate changes in risk over time, adjusted for age, sex and Charlson Comorbidity Index.

Results: A total of 20 826 procedures were included. The overall incidence of pacemaker implantation was 16.8%, increasing from 15.2% in 2017 to 18.2% in 2022 (p<0.001). This increase was independent of age, sex and Charlson index. No modifying effect of hospital procedural volume on the rising pacemaker risk was identified.

Conclusions: The risk of permanent pacemaker implantation after TAVI has increased in Spain between 2017 and 2022. This increase was independent of demographic factors, comorbidities or hospital procedural volume. These findings highlight the need to optimise patient selection and improve TAVI implantation strategies to reduce this complication.