Will You Need a Pacemaker After a TAVR?

One of the most common concerns patients have before undergoing a Transcatheter Aortic Valve Replacement (TAVR) is whether they will need a pacemaker afterward. While not everyone who undergoes a TAVR ultimately requires a pacemaker, for some patients, it becomes a necessary part of their care. Therefore, it is often discussed during consultation with their cardiologist. Understanding why a pacemaker may be necessary and who is most at risk can help you be more informed and prepared.

What Is TAVR?

People typically need a TAVR (Transcatheter Aortic Valve Replacement) when they have severe aortic stenosis, in which the heart’s aortic valve becomes narrowed and stiff, restricting blood flow from the heart. As the valve narrows, the heart works harder to pump blood, which can eventually lead to fatigue, chest pain, shortness of breath, fainting, or even heart failure and sudden death if left untreated.

TAVR is a minimally invasive procedure used to treat severe aortic stenosis. A significant benefit of TAVR over traditional open-heart surgery is that the procedure allows an interventional cardiologist to place a new valve using a catheter inserted through an artery in the leg, rather than opening the chest.

Once placed, the new valve expands, pushing the old valve leaflets aside and restoring normal blood flow.

When Do People Need a TAVR?

TAVR is often recommended for patients whose aortic stenosis is severe and symptomatic, especially if they are at high or intermediate surgical risk due to age or other health conditions such as lung disease, kidney disease, or past heart surgeries. That said, TAVR is often used in lower-risk patients, too, because of its exceptional outcomes and less invasive approach than traditional open-heart surgery.

Why Would You Need a Pacemaker After TAVR?

While the approach is less invasive and recovery is typically quicker than open surgery, the new valve is placed close to the heart’s electrical conduction system—the wiring that controls the heartbeat.
In particular, the bundle of His and the atrioventricular (AV) node—two critical components of the heart’s internal electrical wiring—run just beneath the aortic valve. The pressure or positioning of the new valve can sometimes interfere with this conduction pathway. If the electrical heartbeat signals are disrupted, severe rhythm disturbances, such as complete heart block, may occur, where the upper and lower chambers of the heart no longer communicate effectively. A pacemaker may be necessary to take over this role and maintain the heart’s normal rhythm.

How Common Is It?

The need for a pacemaker after TAVR is not uncommon, but it doesn’t happen to everyone. Studies show that 10 to 20 percent of patients undergoing TAVR require a pacemaker during or shortly after the procedure. Whether you fall into this category depends on several individual risk factors.

Patients with pre-existing conduction issues, such as a right bundle branch block, are at highest risk of needing a pacemaker. The type of valve used also plays a role. For instance, self-expanding valves are more likely to affect the conduction system than balloon-expandable valves. Older patients or those with specific anatomical features may also have an increased risk.

When Would a Pacemaker Be Implanted?

The decision on the need for a pacemaker is generally made during the hospital stay. Most rhythm issues caused by TAVR typically appear within the first 48 to 72 hours after the procedure, so patients are closely monitored in a hospital setting. Sometimes, a temporary pacemaker is placed during the procedure if your interventional cardiologist anticipates that rhythm issues might occur.

If your heart’s rhythm doesn’t recover or if you develop profound bradycardia (a dangerously slow heart rate) or complete heart block, a permanent pacemaker will be recommended.

In rare cases, patients may develop delayed conduction issues that appear days or weeks after discharge, often necessitating a pacemaker.

Can the Risk Be Predicted or Prevented?

While there’s no way to predict who will need a pacemaker after TAVR, your healthcare team can assess your risk based on imaging, electrocardiograms (ECGs), and medical history. If you’re considered at high risk for conduction complications, they may discuss the possibility of a pacemaker before you even undergo the procedure.
In terms of prevention, the cardiologists’ experience, the choice of valve type, and precise placement by experienced interventional cardiologists can reduce the likelihood of damage to the heart’s electrical system. That said, sometimes conduction issues are unavoidable due to the proximity of the valve and the heart’s conduction tissue.

The Bottom Line

In summary, while not everyone requires a pacemaker after TAVR, a significant subset of patients, especially those with prior conduction system disease or anatomical risk factors, will benefit from a pacemaker. The good news is that patients requiring a pacemaker often significantly improve their quality of life by maintaining a regular heart rhythm.

If you are preparing for TAVR or have recently undergone the procedure, it is important to discuss your risk, what signs to watch for, and how your medical team plans to monitor your heart rhythm during recovery. Being informed can help you approach the procedure with greater confidence and peace of mind.