Conduction system pacing after TAVR linked to improved outcomes in new meta-analysis

May 26, 2026 - 17:35

A new meta-analysis suggests that conduction system pacing (CSP) leads to better outcomes for patients who need a permanent pacemaker after transcatheter aortic valve replacement (TAVR). Researchers pooled data from nearly 800 patients across multiple studies, looking at a broad range of clinical results.

The analysis focused on comparing CSP, which includes His-bundle pacing and left bundle branch area pacing, to traditional right ventricular pacing. Patients who received CSP after TAVR showed lower rates of heart failure hospitalizations and improved left ventricular function over time. The data also indicated a reduction in all-cause mortality among the CSP group, though researchers noted the need for larger randomized trials to confirm this finding.

One key concern after TAVR is the development of high-degree atrioventricular block, which often requires a permanent pacemaker. Traditional pacing from the right ventricle can worsen heart function over the long term, especially in patients who already have reduced ejection fraction. CSP aims to maintain a more natural electrical activation of the heart, preserving its pumping efficiency.

The meta-analysis included studies from several countries and covered a variety of TAVR valve types. While the results are promising, the authors emphasized that patient selection and operator experience remain critical. They also pointed out that the procedure can be technically more challenging than standard pacing, especially in the setting of a recently implanted aortic valve. the findings support a shift toward CSP when pacing is unavoidable after TAVR, but more data from prospective trials is still needed to establish best practices.