Specific recommendations for implantation of each prosthesis , taking into consideration the presence of pre-existent conduction abnormalities and anatomical factors , may be needed to reduce the risk of PPI
Aims The incidence of new-onset conduction abnormalities requiring permanent pacemaker implantation ( PPI ) after transcatheter aortic valve implantation ( TAVI ) with new-generation prostheses remains debated .
This systematic review analyses the incidence of PPI after TAVI  with new-generation devices and evaluates the electrical , anatomical , and procedural factors associated with PPI .
In addition , the incidence of PPI after  TAVI with early generation prostheses was review ed for comparison .
Surgical or Transcatheter Aortic‐Valve Replacement in Intermediate‐Risk Patients
Background Although transcatheter aortic‐valve replacement ( TAVR ) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk , less is known about comparative outcomes among patients with aortic stenosis who are at intermediate surgical risk . Methods We evaluated the clinical outcomes in intermediate‐risk patients with severe , symptomatic aortic stenosis in a r and omized trial comparing TAVR ( performed with the use of a self‐exp and ing prosthesis ) with surgical aortic‐valve replacement . The primary end point was a composite of death from any cause or disabling stroke at 24 months in patients undergoing attempted aortic‐valve replacement . We used Bayesian analytical methods ( with a margin of 0.07 ) to evaluate the noninferiority of TAVR as compared with surgical valve replacement . Results A total of 1746 patients underwent r and omization at 87 centers . Of these patients , 1660 underwent an attempted TAVR or surgical procedure . The mean ( ±SD ) age of the patients was 79.8±6.2 years , and all were at intermediate risk for surgery ( Society of Thoracic Surgeons Predicted Risk of Mortality , 4.5±1.6 % ) . At 24 months , the estimated incidence of the primary end point was 12.6 % in the TAVR group and 14.0 % in the surgery group ( 95 % credible interval [ Bayesian analysis ] for difference , ‐5.2 to 2.3 % ; posterior probability of noninferiority , > 0.999 ) . Surgery was associated with higher rates of acute kidney injury , atrial fibrillation , and transfusion requirements , whereas TAVR had higher rates of residual aortic regurgitation and need for pacemaker implantation  . TAVR result ed in lower mean gradients and larger aortic‐valve areas than surgery . Structural valve deterioration at 24 months did not occur in either group . Conclusions TAVR was a noninferior alternative to surgery in patients with severe aortic stenosis at intermediate surgical risk , with a different pattern of adverse events associated with each procedure . ( Funded by Medtronic ; SURTAVI Clinical Trials.gov number , NCT01586910 .
Specific recommendations for implantation of each prosthesis , taking into consideration the presence of pre-existent conduction abnormalities and anatomical factors , may be needed to reduce the risk of PPI
Aims The incidence of new-onset conduction abnormalities requiring permanent pacemaker implantation ( PPI ) after transcatheter aortic valve implantation ( TAVI ) with new-generation prostheses remains debated .
This systematic review analyses the incidence of PPI after TAVI  with new-generation devices and evaluates the electrical , anatomical , and procedural factors associated with PPI .
In addition , the incidence of PPI after  TAVI with early generation prostheses was review ed for comparison .