Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

Akihiro Tobe; Pieter C Smits; Niels van Royen; Ignacio J Amat-Santos; Martin Hudec; Matjaz Bunc; Ben J L Van den Branden; Peep Laanmets; Daniel Unic; Bela Merkely; Renicus S Hermanides; Vlasis Ninios; Marcin Protasiewicz; Benno J W M Rensing; Pedro L Martin; Fausto Feres; Manuel De Sousa Almeida; Eric van Belle; Axel Linke; Alfonso Ielasi; Matteo Montorfano; Mark Webster; Konstantinos Toutouzas; Emmanuel Teiger; Francesco Bedogni; Michiel Voskuil; Manuel Pan; Oskar Angerås; Won-Keun Kim; Jürgen Rothe; Ivica Kristić; Vicente Peral; Scot Garg; Geert A A Versteeg; Mario García Gómez; Tsung-Ying Tsai; Ashokkumar Thakkar; Udita Chandra; Marie-Claude Morice; Yoshinobu Onuma; Andreas Baumbach; Patrick W Serruys

doi:10.1016/j.ijcard.2026.134525

Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

Akihiro Tobe
, Pieter C Smits
, Niels van Royen
, Ignacio J Amat-Santos
, Martin Hudec
, Matjaz Bunc
, Ben J L Van den Branden
, Peep Laanmets
, Daniel Unic
, Bela Merkely
, Renicus S Hermanides
, Vlasis Ninios
, Marcin Protasiewicz
, Benno J W M Rensing
, Pedro L Martin
, Fausto Feres
, Manuel De Sousa Almeida
, Eric van Belle
, Axel Linke
, Alfonso Ielasi

Matteo Montorfano, Mark Webster, Konstantinos Toutouzas, Emmanuel Teiger, Francesco Bedogni, Michiel Voskuil, Manuel Pan, Oskar Angerås, Won-Keun Kim, Jürgen Rothe, Ivica Kristić, Vicente Peral, Scot Garg, Geert A A Versteeg, Mario García Gómez, Tsung-Ying Tsai, Ashokkumar Thakkar, Udita Chandra, Marie-Claude Morice, Yoshinobu Onuma, Andreas Baumbach, Patrick W Serruys^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI.

METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up.

RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02.

CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.

Original language	English
Article number	134525
Journal	International Journal of Cardiology
Volume	456
Early online date	25 Apr 2026
DOIs	https://doi.org/10.1016/j.ijcard.2026.134525
Publication status	Published - 1 Aug 2026

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Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trialFinal published version, 1.52 MBLicence: CC BY

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Tobe, A., Smits, P. C., van Royen, N., Amat-Santos, I. J., Hudec, M., Bunc, M., Van den Branden, B. J. L., Laanmets, P., Unic, D., Merkely, B., Hermanides, R. S., Ninios, V., Protasiewicz, M., Rensing, B. J. W. M., Martin, P. L., Feres, F., Almeida, M. D. S., van Belle, E., Linke, A., ... Serruys, P. W. (2026). Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial. International Journal of Cardiology, 456, Article 134525. https://doi.org/10.1016/j.ijcard.2026.134525

@article{94822d48c5aa4cdabfb692a659d419f5,

title = "Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial",

abstract = "BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1\% at 1 year after TAVI.METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9\%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1\% at follow-up.RESULTS: PMR occurred in 18\% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25\% (11/44), Sapien 19\% (5/27), and Evolut 7\% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95\% confidence interval 0.00-0.77, p = 0.02.CONCLUSIONS: At 1 year, conduction system recovery (VP≦1\%) was observed in 18\% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.",

author = "Akihiro Tobe and Smits, \{Pieter C\} and \{van Royen\}, Niels and Amat-Santos, \{Ignacio J\} and Martin Hudec and Matjaz Bunc and \{Van den Branden\}, \{Ben J L\} and Peep Laanmets and Daniel Unic and Bela Merkely and Hermanides, \{Renicus S\} and Vlasis Ninios and Marcin Protasiewicz and Rensing, \{Benno J W M\} and Martin, \{Pedro L\} and Fausto Feres and Almeida, \{Manuel De Sousa\} and \{van Belle\}, Eric and Axel Linke and Alfonso Ielasi and Matteo Montorfano and Mark Webster and Konstantinos Toutouzas and Emmanuel Teiger and Francesco Bedogni and Michiel Voskuil and Manuel Pan and Oskar Anger{\aa}s and Won-Keun Kim and J{\"u}rgen Rothe and Ivica Kristi{\'c} and Vicente Peral and Scot Garg and Versteeg, \{Geert A A\} and G{\'o}mez, \{Mario Garc{\'i}a\} and Tsung-Ying Tsai and Ashokkumar Thakkar and Udita Chandra and Marie-Claude Morice and Yoshinobu Onuma and Andreas Baumbach and Serruys, \{Patrick W\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = aug,

day = "1",

doi = "10.1016/j.ijcard.2026.134525",

language = "English",

volume = "456",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Tobe, A, Smits, PC, van Royen, N, Amat-Santos, IJ, Hudec, M, Bunc, M, Van den Branden, BJL, Laanmets, P, Unic, D, Merkely, B, Hermanides, RS, Ninios, V, Protasiewicz, M, Rensing, BJWM, Martin, PL, Feres, F, Almeida, MDS, van Belle, E, Linke, A, Ielasi, A, Montorfano, M, Webster, M, Toutouzas, K, Teiger, E, Bedogni, F, Voskuil, M, Pan, M, Angerås, O, Kim, W-K, Rothe, J, Kristić, I, Peral, V, Garg, S, Versteeg, GAA, Gómez, MG, Tsai, T-Y, Thakkar, A, Chandra, U, Morice, M-C, Onuma, Y, Baumbach, A & Serruys, PW 2026, 'Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial', International Journal of Cardiology, vol. 456, 134525. https://doi.org/10.1016/j.ijcard.2026.134525

TY - JOUR

T1 - Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation

T2 - A sub-study of the LANDMARK trial

AU - Tobe, Akihiro

AU - Smits, Pieter C

AU - van Royen, Niels

AU - Amat-Santos, Ignacio J

AU - Hudec, Martin

AU - Bunc, Matjaz

AU - Van den Branden, Ben J L

AU - Laanmets, Peep

AU - Unic, Daniel

AU - Merkely, Bela

AU - Hermanides, Renicus S

AU - Ninios, Vlasis

AU - Protasiewicz, Marcin

AU - Rensing, Benno J W M

AU - Martin, Pedro L

AU - Feres, Fausto

AU - Almeida, Manuel De Sousa

AU - van Belle, Eric

AU - Linke, Axel

AU - Ielasi, Alfonso

AU - Montorfano, Matteo

AU - Webster, Mark

AU - Toutouzas, Konstantinos

AU - Teiger, Emmanuel

AU - Bedogni, Francesco

AU - Voskuil, Michiel

AU - Pan, Manuel

AU - Angerås, Oskar

AU - Kim, Won-Keun

AU - Rothe, Jürgen

AU - Kristić, Ivica

AU - Peral, Vicente

AU - Garg, Scot

AU - Versteeg, Geert A A

AU - Gómez, Mario García

AU - Tsai, Tsung-Ying

AU - Thakkar, Ashokkumar

AU - Chandra, Udita

AU - Morice, Marie-Claude

AU - Onuma, Yoshinobu

AU - Baumbach, Andreas

AU - Serruys, Patrick W

PY - 2026/8/1

Y1 - 2026/8/1

N2 - BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI.METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up.RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02.CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.

AB - BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI.METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up.RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02.CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.

U2 - 10.1016/j.ijcard.2026.134525

DO - 10.1016/j.ijcard.2026.134525

M3 - Article

C2 - 42044716

SN - 0167-5273

VL - 456

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 134525

ER -

Pacemaker recovery after permanent pacemaker implantation post-transcatheter aortic valve implantation: A sub-study of the LANDMARK trial

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