Paravalvular leak versus need for permanent pacemaker after TAVR: Sailing between Scylla and Charybdis

Key Points

• Absence or minimization of PVL after TAVR and its potential association with higher rates of PPM placement has been the Achilles' heel of TAVR procedures.
• Pre-existing RBBB and depth of implantation are independent predictors of PPM need after Lotus valve implantation.
• Optimization of device design, increased operator experience, and focus on accurate device placement seem to result in decreased need for PPM after Lotus valve implantation.

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