Aims: Conduction disturbance requiring permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve implantation (TAVI) using Medtronic self-expanding CoreValve. This complication is still common even after the introduction of new generation CoreValve Evolut R. The aim of this study was to identify the determinants of PPM implantation after TAVI using CoreValve Evolut R.

Methods and results: We retrospectively analyzed 116 patients undergoing transfemoral TAVI using CoreValve Evolut R. We excluded 16 with preprocedural PM, 1 patient requiring Edwards SAPIEN 3 implantation after Evolut R implantation, and 4 patients who died during the hospital admission, and finally included 93 patients in the analysis. A total of 18 patients (19%) underwent PPM implantation after TAVI. Preprocedural electrocardiography showed that ventricular late was lower and right bundle branch block was more common in patients with new PPM implantation. Quantitative multidetector computed tomography assessment showed that larger aortic valve calcification (AVC) and larger ∆ AVC were more common in patients with new PPM implantation. Multivariable logistic regression analysis demonstrated that preprocedural ventricular rate≤ 70 bpm (odds ratio (OR) 6.2, p = 0.002) and ∆ AVC ≥45 mm3 (OR 3.8, p = 0.039) were independently associated with new PPM implantation

Conclusion: PPM implantation occurs in 19 % after TAVI with new-generatin CoreValve Evolut R. Preprocedural ventricular rate≤ 70 bpm and ∆ AVC ≥45 mm3 are independently associated with new PPM implantation, suggesting a prognostic role of bradycardia and asymmetric AVC distribution in the development of subsequent conduction disturbance requiring PPM implantation after TAVI using new generation CoreValve Evolut R.