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PPM After TAVI — EECC MCQ

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ModerateValvular Heart DiseasePPM After TAVIEECC

A 72-year-old man undergoes TAVI with a self-expanding valve for severe AS. Post-procedure he develops new complete LBBB with intermittent PR prolongation. Continuous telemetry at 48 hours shows one episode of complete heart block lasting 8 seconds with a ventricular escape at 30 bpm. What is the appropriate management?

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Correct answer: B — Permanent pacemaker implantation is indicated for high-degree AV block post-TAVI, even if intermittent, given the risk of asystole

The 2025 ESC VHD Guidelines and 2021 ESC Pacing Guidelines recommend permanent pacemaker implantation for: (1) persistent high-degree or complete AV block post-TAVI; (2) intermittent high-degree AV block post-TAVI (as in this case) given the risk of unpredictable recurrence and potential asystole. New LBBB post-TAVI occurs in 5-30% of cases (higher with self-expanding valves), and progression to high-degree AV block occurs in ~5-15% of those with new LBBB. Patients with new LBBB plus PR prolongation (as here) are at particularly high risk. Ambulatory monitoring (7-day Holter or implantable loop recorder) may be considered for patients with isolated new LBBB without AV block to guide the pacing decision.

Reference: ESC/EACTS (2025): VHD Guidelines; ESC (2021): Pacing Guidelines