Letter: Permanent pacing after TAVI for aortic regurgitation: distinctive predictors in a new landscape

We congratulate Wienemann and colleagues on their important contribution to the field of structural heart interventions, reporting a 24.1% rate of permanent pacemaker implantation (PPI) in pure aortic regurgitation (AR) patients undergoing transcatheter aortic valve implantation (TAVI) with the JenaValve Trilogy system (JenaValve Technology). As TAVI indications extend beyond aortic stenosis (AS), their study provides timely and clinically relevant insights into conduction disturbances in this unique patient population1. In AS, PPI post-TAVI is a well-recognised complication primarily driven by mechanical compression of the conduction system, particularly from deep valve implantation and radial force from self-expanding prostheses2. Large registries such as the STS/ACC TVT Registry consistently report PPI rates of ~10-11% in AS populations, despite ongoing improvements in device design and operator experience3. The NEOPRO and NEOPRO-2 registries (n=3,211) showed similar results, identifying right bundle branch block (RBBB) and depth of implantation as independent predictors of PPI4. These findings support the utility of mechanical and anatomical markers to guide risk prediction in TAVI for AS. In contrast, Wienemann et al identified only baseline conduction disturbances – first-degree...