Mechanical Factors Necessitating Pacemaker Implantation after Transcatheter Aortic Valve Replacement
Daxin Zhou *, Yiming Qi ,Abstract
Complications of Transcatheter Aortic Valve Replacement (TAVR) often result in a need for subsequent permanent pacemaker implantation. However, the risk factors for delayed pacemaker implantation remain unclear. Characteristics of TAVR prostheses and aortic root anatomy determine their mechanical relationships, which might damage the conduction bundle. At present, it is believed that the continuous compression of surrounding tissues by Self-Expandable Valves (SEV) after implantation is one of the main mechanisms of delayed pacemaker implantation. Exploring the mechanical sequelae of implantation might provide a basis for future predictions. This article summarizes and discusses current literature regarding the mechanical sequelae of TAVR.
Introduction
Permanent Pacemaker Implantation (PPMI) is often required after Transcatheter Aortic Valve Replacement (TAVR) due to complications [1,2]. Permanent left bundle branch block developed in approximately 22.7% of patients undergoing TAVR and 5.9%-32.0% of them require PPMI [3]. Pacemaker implantation not only increases the economic burden of patients and the length of hospital stays but might also increase mortality rates [4].
The need for delayed PPMI after TAVR has recently increased, which might be attributed to early discharge and post-discharge surveillance [5]. The complications of TAVR can result in syncope and occur outside the hospital, which could be fatal for elderly patients. However, predicting the need for delayed PPMI is challenging, and associated risk factors are unknown. Current literature suggests that persistent compression of surrounding tissues by Self-Expandable Valves (SEVs) might be a key factor driving the need for PPMI.
LITERATURE REVIEW
Direct measurement of stress around valve implants is challenging. Research has chiefly focused on the anatomical evaluation of the aortic root through imaging, physical characteristics of the valve stent, and preoperative prediction of the pressure exerted by the stent on the aortic root and left ventricular outflow tract through Finite Element Analysis (FEA). FEA is a modern mathematical and computer modeling method widely used in the development of medical devices. It enables an in-depth analysis of the interaction forces between tissues and implants [7,8]. Two TAVR modeling methods are currently based on FEA. One is universal and based on the average aortic root geometry of numerous patients or on simplified aortic root geometry with a complex structure [9,10]. The second involves three-dimensional reconstruction of an aortic root model of a single patient using Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). In this method, the anatomical model, obtained using MRI or CT, combined with the characteristics of the memory-metal used in the prosthesis, can simulate and predict the TAVR procedure through computer simulation [11].
Author Info
1 Department of Cardiology, Fudan University, Shanghai, ChinaReceived: 16-Jun-2025, Manuscript No. JCEC-23-26104; Editor assigned: 18-Jun-2025, Pre QC No. JCEC-23-26104 (PQ); Reviewed: 02-Jul-2025, QC No. JCEC-23-26104; Revised: 08-Jul-2025, Manuscript No. JCEC-23-26104 (R); Published: 15-Jul-2025
Citation: Zhou D, Qi Y, Chen S, Hou S, Ge J (2023) Mechanical Factors Necessitating Pacemaker Implantation after Transcatheter Aortic Valve Replacement. J Clin Exp Cardiolog. 14:826.
Copyright: © 2023 Zhou D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
