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 .
A Highly Predictive Risk Model for Pacemaker Implantation After TAVR.
OBJECTIVES This study sought to develop a robust and definitive risk model for new permanent pacemaker implantation ( PPMI ) after SAPIEN 3 ( third generation balloon exp and able valve )  ( Edwards Lifesciences , Irvine , California ) transcatheter aortic valve replacement ( third generation balloon exp and able valve TAVR ) , including calcification in the aortic-valvular complex ( AVC ) . BACKGROUND The association between calcium in the AVC and need for PPMI is poorly delineated after third generation balloon exp and able valve TAVR . METHODS At Cedars-Sinai Heart Institute in Los Angeles , California , a total of 240 patients with severe aortic stenosis underwent third generation balloon exp and able valve TAVR and had contrast computed tomography .  AVC was characterized precisely by leaflet sector and region . RESULTS The total new PPMI rate was 14.6 % . On multivariate analysis for predictors of PPMI , pre-procedure third generation balloon exp and able valve TAVR , right bundle branch block ( RBBB ) , shorter membranous septum ( MS ) length , and noncoronary cusp device-l and ing zone calcium volume ( NCC-DLZ CA ) were included . Predictive probabilities were generated using this logistic regression model . If 3 pre-procedural risk factors were present , the c-statistic of the model for PPMI was area under the curve of 0.88 , sensitivity of 77.1 % , and specificity of 87.1 % ; this risk model had high negative predictive value ( 95.7 % ) . The addition of the procedural factor of device depth to the model , with the parameter of difference between implantation depth and MS length , combined with RBBB and NCC-DLZ CA increased the c-statistic to 0.92 , sensitivity to 94.3 % , specificity to 83.8 % , and negative predictive value to 98.8 % CONCLUSIONS : By using a precise characterization of distribution of calcification in the AVC in a single-center , retrospective study , NCC-DLZ CA was found to be an independent predictor of new PPMI post-third generation balloon exp and able valve TAVR . The findings also reinforce the importance of short MS length , pre-existing RBBB , and ventricular implantation depth as important synergistic PPMI risk factors . This risk model will need validation by future prospect i ve multicenter studies
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 .