Impact of Early Versus Delayed Permanent Pacemaker Implantation on Clinical Outcomes in Patients with Third-Degree Atrioventricular Block After Transcatheter Aortic Valve Replacement: A National Inpatient Sample Analysis

Background Third-degree atrioventricular (AV) block following transcatheter aortic valve replacement (TAVR) often necessitates permanent pacemaker (PPM) implantation. However, the impact of PPM timing on clinical outcomes remains unclear. Methods Utilizing the National Inpatient Sample (2016–2021), we identified third degree AV block patients who received PPM during the same admission period after TAVR. Cohorts were defined as early (≤ 72h) or delayed (> 72h) implantation. In-hospital mortality constituted the primary endpoint, while the duration of hospitalization and the costs incurred were designated as secondary endpoints. Multivariable logistic regression was employed to calculate adjusted odds ratios (aOR) or adjusted beta (aβ). Results In an adjusted analysis of 3,385 patients exhibiting third-degree AV block post-TAVR who underwent permanent pacemaker implantation, no significant variation in in-hospital mortality was detected between the two cohorts (aOR 1.25, 95% CI 0.59–2.66), but the delayed group experienced a 6.30-day longer LOS (aβ: 6.30; 95% CI, 5.96–6.63) and incurred $81,572.80 more in hospitalization costs (aβ: 81,572.8; 95% CI 69,542.5–93,606.1). Delayed PPM is associated with anemia, coagulation disorders, congestive heart failure, and chronic kidney disease (All P < 0.001). Conclusion In this national cohort, we found that delaying PPM after TAVR-related third-degree AV block did not increase in-hospital mortality but resulted in higher hospital costs and longer stays. Correctable hematological and cardiorenal dysfunction independently associated with delayed implantation of PPM.