Search Results (288)

Background/Objectives: Aortic valve therapy increasingly follows a lifetime management concept. As all bioprostheses ultimately degenerate, optimal outcomes rely on the appropriate selection and timing of treatment modality. This study evaluates outcomes of redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) in a consecutive, unselected real-world cohort treated for bioprosthetic valve failure (BVF). Methods: A single-center retrospective analysis of all patients undergoing redo-SAVR or ViV-TAVR for BVF between June 2019 and December 2024 was conducted. The primary endpoint was survival at 30 days and at 1, 3, and 5 years; the secondary endpoint was time to reintervention. Cox proportional hazards models were used; proportionality was tested; subgroups were defined by indication and presence of concomitant procedures. Results: Eighty-three patients were included (redo-SAVR n = 42; ViV-TAVR n = 41). All active endocarditis cases were managed surgically. In isolated procedures, 30-day survival was 95.5% after redo-SAVR (100% when excluding endocarditis) and 100% after ViV-TAVR; 5-year survival was 81.3% and 94.1%, respectively (94.4% for isolated redo-SAVR excluding endocarditis). Because hazards were non-proportional and risk sets were sparse beyond 5 years, we fitted a time-split Cox model (0–5 years). In multivariable analysis, endocarditis (HR 4.45, 95% CI 1.16–17.04) and NYHA IV (HR 4.87, 95% CI 0.98–24.17)—not treatment modality—were associated with mortality. Conclusions: In a real-world, all-comers setting, early outcomes for isolated reinterventions were favorable with both pathways. Mortality patterns were case-mix driven—especially by endocarditis and the need for concomitant surgery. Accordingly, ViV-TAVR and redo-SAVR should be viewed not as competing procedures but as complementary, scenario-specific options within a lifetime management strategy. Full article

Objectives: An increasing number of older adults, including those with mild cognitive impairment, are undergoing cardiac surgery. Despite strong recommendations for preoperative cognitive screening and peri-operative monitoring, routine implementation faces challenges, such as limited time in busy outpatient clinics and lack of patient motivation. To address this issue, gamification and self-administration of cognitive screening using BAMCOG were explored in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: A multi-methods prospective repeated-measures within-subject cohort study was conducted between January 2021 and December 2022 to assess usability and concurrent validity. The initial part after game development focused on qualitatively examining the usability of BAMCOG in eight patients, using the System Usability Scale (SUS). The second part, with 40 patients, evaluated concurrent validity by comparing BAMCOG with the widely used Montreal Cognitive Assessment (MoCA). Results: The average SUS score was 79.7, indicating good usability. In the preoperative period, the correlation between BAMCOG and MoCA scores was r = 0.33 (p < 0.05), which increased to r = 0.59 (p < 0.001) on the first postoperative day. Conclusions: In conclusion, peri-operative self-monitoring of cognition around a TAVR procedure is feasible, but the concurrent validity of the BAMCOG and the MoCA scores is moderate to low. This warrants further research on gamified cognitive screeners to optimize their use in perioperative cognitive monitoring. Full article

Severe aortic stenosis represents a significant prognostic burden, particularly in symptomatic patients. The advent of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients previously considered ineligible for surgical aortic valve replacement (SAVR). TAVR provides a relatively safe intervention that leads to improvements in survival, symptoms, and functional status within months of implantation. A major complication following TAVR is the occurrence of paravalvular leaks (PVLs), which have been associated with increased mortality and higher rates of heart failure-related hospitalizations. PVLs refer to abnormal blood flow between the implanted valve and the aortic wall, which can compromise the functionality of the device. Careful pre-procedural planning enables the identification of patients at higher risk for PVL development. Although the incidence of PVLs has decreased with the introduction of newer-generation transcatheter valves, the condition remains clinically relevant. Due to the complex anatomy of the aortic valve apparatus and interference from the prosthetic frame, accurate evaluation of PVLs requires a multimodal diagnostic approach. Current evidence on PVL management is limited. In most cases, a conservative approach is adopted, while interventional strategies (such as pre- and post-dilatation, percutaneous PVL closure, and TAVR-in-TAVR) are reserved for selected patients. We performed a systematic literature review to summarize the incidence, predictors, diagnostic techniques, and management strategies of PVLs following TAVR. Full article

Objective: Prosthesis–patient mismatch (PPM) occurs after aortic valve replacement (AVR) when the effective orifice area of the implanted prosthetic valve is small relative to the patient’s body surface area. Beyond simply elevating transvalvular gradient, PPM profoundly affects cardiac remodeling, coronary physiology, and ultimately patient survival. This comprehensive review synthesizes current evidence regarding PPM pathophysiology, clinical consequences, and therapeutic strategies. Methods: We conducted a narrative review of PPM in surgical (SAVR) and transcatheter (TAVR) aortic valve replacement. PubMed and Embase were systematically searched using terms related to AVR and PPM and reference lists of key studies and reviews were screened. Studies addressing PPM prevalence, hemodynamic impact, clinical outcomes, and mitigation strategies were included. Results: PPM, defined as an iEOA ≤ 0.85 cm²/m² (moderate) or ≤0.65 cm²/m² (severe), demonstrates variable prevalence across studies, typically ranging from 5 to 30% after SAVR and 2–35% after TAVR. It is associated with increased transvalvular gradients, reduced left ventricular mass regression, persistent coronary flow abnormalities, higher rates of heart failure, and both early and late mortality. Supra-annular self-expanding transcatheter aortic valve replacement (TAVR) devices and newer generation stentless or bovine pericardial surgical valves exhibit lower PPM rates than older stented or porcine valves. Valve-in-valve (ViV) TAVR and bioprosthetic valve fracture (BVF) can improve outcomes in failed surgical valves but are less effective in small annuli. TAVR-in-TAVR procedures are limited by anatomic and technical constraints, especially in maintaining coronary access and minimizing residual gradients. Conclusions: PPM remains a common and clinically consequential complication of AVR that compromises long-term outcomes. It is largely preventable through accurate preoperative imaging, valve sizing, and consideration of annular enlargement. Optimal outcomes require matching valve characteristics to individual patient anatomy and physiology. In an era of expanding TAVR use, preventing PPM during the index procedure is critical to optimizing survival and preserving future reintervention options. Full article

Background/Objectives: The increasing use of endovascular procedures with common femoral artery (CFA) access has led to a rise in iatrogenic arterial injuries at this site. The most frequent injuries are pseudoaneurysms (PSA), retrograde dissections (RD), arteriovenous fistulas (AVF), and arterial perforations. Surgical repair is the standard treatment; however, the use of covered stents (CS) may represent a valid alternative, despite current instructions for use (IFU) not recommending CFA implantation. Methods: We conducted a single-center retrospective study on a prospectively maintained database. Patients undergoing transcatheter aortic valve repair (TAVR), endovascular aortic repair EVAR, diagnostic or therapeutic coronary angiography, or peripheral percutaneous transluminal angioplasty, who were subsequently treated for CFA injury with CS implantation between February 2015 and May 2024, were included. Endpoints were technical success (complete arterial repair), 30-day mortality, overall mortality, reintervention rates, and long-term stent patency. Results: A total of 41 patients were included: 10 (24.4%) PSA, 3 (7.3%) AVF, 27 (65.8%) perforations, and 2 (4.9%) RD. Of which 28 (68.3%) were treated with self-expandable CS and 13 (31.7%) with balloon-expandable CS. Additionally, 33 (80.5%) underwent urgent treatment. Technical success was achieved in 97.5%. Thirty-day mortality was 7.3%, with no procedure-related deaths. At a mean follow-up of 50.8 months (range 1–109), survival was 63.4%, with 100% stent patency and no procedure-related reinterventions. Conclusions: CS implantation for CFA iatrogenic injuries achieved high technical success and excellent long-term patency, representing a viable alternative to open repair. Further studies are needed to integrate CS use for CFA injuries into treatment algorithms and to update device IFUs accordingly. Full article

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal minimally invasive interventional therapy for aortic valve disease and has seen increasingly widespread clinical adoption in recent years. Despite its overall safety, the adverse events and even deaths in the postoperative period still account for a certain percentage. Accurate identification of high-risk patients is therefore critical for optimizing preoperative decision making, guiding individualized treatment strategies and improving long-term outcomes. However, existing scoring systems and predictive models fail to fully leverage multimodal clinical data from patients, resulting in suboptimal predictive accuracy that falls short of the demands of precision medicine, indicating substantial room for improvement. Methods: In this study, a multimodal deep learning model named MULTINet (multimodal learning for TAVR risk network) was constructed using data from the MIMIC-IV (Medical Information Mart for Intensive Care) cohort. This model achieved unimodal and multimodal modeling through a dual-branch structure, and, by using an attention pooling fusion module, flexibly handled the input that contained missing modalities, to predict the 30-day all-cause mortality in TAVR patients. The area under the receiver operating characteristic curve (AUC), the area under the precision–recall curve (AUPR) and the recall rate were used for prediction evaluation. The calibration degree was evaluated by calibration diagrams and Brier scores, and its clinical practicability was assessed through decision curve analysis (DCA). And the integrated gradient method was used to identify key predictive features to enhance interpretability of the model. Results: In the postoperative 30-day all-cause mortality prediction task, the MULTINet method achieved an AUC value of 0.9153, AUPR value of 0.5708 and Recall value of 0.8051, which was significantly superior to the XGBoost method (AUC 0.8958, AUPR 0.4053 and Recall 0.7793) and the MedFuse method (AUC 0.5571, AUPR 0.2487 and Recall 0.3089). The MULTINet method demonstrated more robust and reliable probability estimation performance, with a Brier score of 0.0269, outperforming XGBoost (0.0343) and MedFuse (0.2496). It achieved a higher net benefit in decision analysis, reflecting its effectiveness in strategy optimization and actual decision-making benefits. The renal function, cardiac function and inflammation-related indicators contributed greatly in the prediction process. Conclusions: The multimodal deep learning model proposed in this study named MULTINet enables adaptive integration of multimodal clinical information for predicting all-cause mortality within 30 days post-TAVR, substantially improving both predictive accuracy and clinical applicability, providing robust support for clinical decision making and boosting TAVR management toward greater precision and intelligence. Full article

Background: Cardiac implantable electronic devices (CIEDs) have become indispensable tools in the management of bradyarrhythmia and heart failure, prompting a surge in research activity. To characterize the evolving research landscape, we conducted a bibliometric analysis focused on institutional contributions, author networks, journal trends, funding patterns, and emerging thematic hotspots in the field of cardiac devices to highlight keywords and identify knowledge development timelines and emerging trends, providing a comprehensive overview of the current state of research in this area. Methods: We conducted a bibliometric analysis of cardiac devices using the Web of Science Core Collection (WOSCC) on 27 November 2024, with search terms “ST (cardiac defibrillator) OR (pacemaker)”. Data from 1 January 2019 to 1 January 2024 resulted in 3753 articles, refined to 1000 after excluding non-English and methodologically inappropriate papers. VosViewer, Excel, and Drawio facilitated data visualization, creating networks where node size indicates frequency, line thickness shows association strength, and colors denote clusters. This approach helped identify key research trends and collaborations in the field. Results: The United States led in publication volume (362 papers) and citations (7198), with Emory University emerging as the most prolific institution. Heart Rhythm was the most productive journal, while Europace was the most co-cited. Kurt Stromberg was the leading author by publications and citations. Funding was predominantly from U.S. agencies, with the NIH and HHS each supporting 127 studies. Co-citation and keyword analyses revealed three dominant research clusters: (1) leadless pacemakers; (2) permanent pacemaker implantation following transcatheter aortic valve replacement (TAVR); and (3) development of self-powered pacing technologies, including piezoelectric and bioresorbable systems. Conclusions: This study offers a comprehensive overview of recent trends and intellectual structures in cardiac device research. By identifying key contributors, collaborative networks, and thematic evolutions, it provides a valuable reference for researchers, clinicians, and innovators seeking to navigate or shape the rapidly advancing field of cardiac electrophysiology and device therapy. Full article

Objective: This analysis compares new (G2) versus old (G1) generations of transcatheter heart valves (THVs) in transcatheter aortic valve replacement (TAVR) procedures, focusing on key outcomes: post-procedural conduction disturbance (CD) and permanent pacemaker implantation (PPMI). We aim to determine whether G2 valves reduce these specific complications and thereby improve patient outcomes compared with G1. Methods: From February 2015 to September 2022, 1468 patients underwent TAVR at the university clinic in Kiel. After applying exclusion criteria, a final cohort of 1182 patients were analysed. Among these, 782 patients underwent TAVR with G1, whereas 400 underwent TAVR with G2. The primary study endpoints were the occurrence of new CD and PPMI within 30 days post-procedure. The secondary endpoints included diverse post-TAVR events as defined by the safety criteria of Valve Academic Research Consortium 3 (VARC III). A statistical analysis compared outcomes between the G1 and G2 groups. Results: Out of 1182 patients, 12.1% required PPMI within 30 days. Rates showed no statistical difference between G2 and G1 for PPMI (10.3% vs. 13.0%, IPTW-weighted p = 0.31) or CD (15.3% vs. 21.48%, IPTW-weighted p = 0.08). Among G2, the Sapien 3 Ultra valve had the lowest PPMI rate (4.8%). Overall, G2 and G1 had similar post-procedural and 30-day mortality rates. Conclusion: G2 valves may reduce post-procedure CD, but the difference is not statistically significant. Differences between specific valve types—such as the Sapien 3 Ultra’s lower rates—are notable, but overall, PPMI and safety profiles remain similar between G1 and G2. Patient and procedural factors still play a significant role. Careful valve and patient selection is essential, and ongoing research will guide further improvements. Full article

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article

Background: Data on high flow nasal oxygenation (HFNO) efficacy in hypoxia prevention in transcatheter aortic valve replacement (TAVR) are conflictive. We aimed to determine the benefit of HFNO in preventing the occurrence of desaturations during TAVR. Methods: An investigator-initiated, proof of concept, single-centre, randomised, and controlled trial on 132 adult patients who were scheduled to undergo transfemoral TAVR was conducted. Patients were randomised (1:1) to HFNO (H-group) with a flow rate of 50 L min⁻¹ and FiO₂ 0.6 or standard of care oxygen therapy (S-group). The primary endpoint was the number of patients with a desaturation episode (SpO₂ < 93%) for >10 s during TAVR. Secondary outcomes included arterial partial pressure of oxygen (pO₂) 45 min from sedation start and changes in glomerular filtration rate from baseline to 12 h post-procedure. Results: Between 23 November and 24 July, a per-protocol analysis was performed in a total of 125 patients (H-group n = 64; S- group n = 61; 49 females). The number of patients with any desaturation episode was significantly lower in the H-group [13/64 (20%, 95% CI: 12–32%)] than in the S-group [31/61 (51%, 95% CI: 39–63%), RR: 0.39 (95%CI: 0.23–0.68)]. At 45 min, mean (SD) pO₂ was higher in the H-group (24(9.8) kPa vs. 16.7(7.5) kPa; p < 0.005). A significant improvement in delta median (IQR) difference on glomerular filtration rate was observed in the H-group [1.6(−1–7.9) mL min⁻¹ 1.73 m⁻²] with respect to the S-group [0.2(−6.1–3.1) mL min⁻¹ 1.73 m⁻²; p-value: 0.013]. Conclusions: This trial demonstrated that HFNO provides a better oxygenation pattern than standard oxygen therapy during TAVR. Larger studies focusing on long-term clinical outcomes are warranted to evaluate the benefit of HFNO during sedation for TAVR procedures. Full article

Introduction: Artificial intelligence (AI) tools have emerged in cardiovascular clinical practice. Regarding transcatheter aortic valve replacement/implantation (TAVR/TAVI) procedures, their utilization optimizes procedural planning, aids physicians with decision making, and predicts possible post-procedural complications. Moreover, machine-learning (ML) models, compared with traditional mortality risk scores, show promising results considering predicted mortality in TAVI patients. However, further validation is required. As the implementation of cardiovascular procedures can be challenging, AI technology broadens the armamentarium of tools that a clinician is able to use for a more comprehensive evaluation of patients, minimizing complications and resulting in optimum clinical outcomes. Methods: A comprehensive literature search was conducted through the PubMed and Google Scholar databases from inception to 20 September 2025, to identify relevant studies. The search strategy included the following keywords: [“TAVI” OR “TAVR”] AND [“AI”, Artificial Intelligence]. Results: According to our database research, 7177 articles were initially screened, and 2145 duplicate articles were excluded. Eventually, 189 articles were evaluated by our reviewers and 51 articles of studies published between 2014 and 2025 were included in our review. Conclusions: AI algorithms could revolutionize the Heart Team decision making process, being not only a tool for patient evaluation but an active member of the team with applications to analyze and optimize all stages of the TAVI procedure, guide decision making and predict outcomes, and, with the contribution and evaluation of information from all human members of the team, enhance even more the patient-mediated medicine/interventions. Full article

Background/Objectives: To report our single-centre experience with the first 100 patients who underwent transcatheter aortic valve replacement (TAVR) with the new balloon-expandable Myval system. We report 3-year outcomes in low- to high-risk TAVR patient populations. Methods: From November 2019 to July 2021, 100 consecutive patients underwent TAVR, and their outcomes were classified according to the Valve Academic Research Consortium 3 definitions. Device performance was assessed using transthoracic echocardiography. Data collection was approved by the local ethical committee. Results: Among the 100 patients, most were male (n = 63), the mean age was 74.7 years, the mean EuroSCORE II score was 4.8 ± 4.9, and the mean Society of Thoracic Surgeons score was 5.6 ± 3.9. All patients were followed up for three years or until death. The rates of all-cause mortality, cardiac mortality and stroke were 28%, 7% and 5%, respectively. After three years, residual moderate aortic regurgitation was detected in eight patients without severe grade, and bioprosthetic valve dysfunction was observed in 17: structural valve deterioration in 10 (only stage 2), non-structural valve deterioration in three (paravalvular leak in one, patient–prosthesis mismatch in two), and endocarditis in four. Definite transcatheter heart valve thrombosis (hypoattenuated leaflet thickening) was not observed. Bioprosthetic valve failure was detected in four patients (stage 1: 1, stage 2: 0, stage 3: 3). After three years of follow-up, survival analysis revealed no significant differences in all-cause mortality, cardiac mortality, or the composite endpoint (including cardiac mortality, stroke and valve-related dysfunction) between patients with bicuspid (BAV) and tricuspid (TAV) aortic valve morphology and across annulus sizes (small, intermediate and large). Conclusions: TAVR resulted in significant and sustained improvements in valve haemodynamics with low rates of valve dysfunction and adverse clinical outcomes over a three-year follow-up period. Valve morphology (BAV vs. TAV) and annulus size did not significantly impact survival, haemodynamic performance, or valve durability. These results support the expanded use of TAVR in diverse patient populations, although extended follow-up is essential to fully establish long-term durability. Full article

Background: Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a severe complication. Surgical explantation of infected transcatheter heart valves (THV) is technically demanding and associated with high mortality. Data on risk factors for perioperative death and long-term outcomes remain limited. Aim: To identify predictors of mortality in patients undergoing surgical aortic valve replacement (SAVR) for IE after TAVR. Methods: We conducted a case–control study of patients treated with SAVR for IE after TAVR at our center between February 2008 and December 2023. Fifteen patients who died in hospital (cases) were compared with 35 perioperative survivors (controls). Hospital survivors were followed for long-term outcomes. Results: Age, sex, comorbidities (kidney disease, cerebrovascular disease, COPD, diabetes, peripheral artery disease), and anthropometrics were similar between groups. Cases had significantly lower left ventricular function and higher logistic EuroSCORE and STS-PROM before surgery. Causative microorganisms, cross-clamp time, and concomitant procedures did not differ. Postoperative pacemaker implantation, rethoracotomy, stroke, and ICU or hospital stay were comparable, while dialysis was more frequent in cases (44% vs. 25.7%). Median follow-up was 294 days (range 1–3802). Survival was 79.8% at 30 days and 67.4% at 1 year. Of 35 hospital survivors, 29 were discharged home, 6 to rehabilitation/other hospitals; 31 remain alive (1 early, 3 late deaths). Conclusions: SAVR for IE after TAVR carries high early mortality (18.1% at 30 days; 32.6% at 1 year). Higher preoperative risk scores and postoperative dialysis were associated with perioperative death. Long-term survival among hospital survivors is favorable, with most patients regaining independent living. Full article

Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm², and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA. Full article

Background: Pre-existing atrial fibrillation (AF) is common among patients undergoing transcatheter aortic valve replacement (TAVR). However, evidence regarding its impact on the risk of permanent pacemaker (PPM) implantation and other conduction disturbances (CDs) after TAVR remains inconsistent. The aim of this study was to assess the effect of baseline heart rhythm on the risk of conduction abnormalities following TAVR. Methods: This study included patients with severe AS who underwent TAVR using either balloon-expandable (BEVs) or self-expanding valves (SEVs). The primary endpoint was the incidence of PPM implantation and new or worsening left bundle branch block (LBBB) after TAVR according to baseline rhythm (sinus rhythm vs. AF). Secondary endpoints were predictors of PPM implantation, LBBB, the occurrence of periprocedural stroke, and in-hospital mortality. Results: A total of 5195 TAVR patients were included: 3560 with baseline sinus rhythm and 1635 with baseline AF. PPM implantation was more frequent in patients with AF than in those with sinus rhythm (17% vs. 15%, p = 0.033), whereas new or worsening LBBB was less common (11% vs. 14%, p = 0.026). After adjustment with multivariable logistic regression, these associations were no longer statistically significant (PPM implantation: OR 1.156, 95% CI 0.969–1.379, p = 0.108; new or worsening LBBB: OR 0.826, 95% CI 0.676–1.010, p = 0.062). Independent peri-procedural predictors of PPM implantation included baseline first-degree AV block, pre-procedural RBBB, the use of self-expandable valves, implantation of larger valve sizes (≥23 mm), and the need for valve repositioning. Conclusions: In this large cohort, baseline AF was not associated with an increased risk of PPM implantation or new onset LBBB compared with sinus rhythm. These findings suggest that baseline rhythm alone should not be considered an independent predictor of PPM implantation or CDs following TAVR. Full article