Background: Long-term right ventricular pacing (VP) has been related to negative leftventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients.

Objectives: The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR.

Methods: PACE-TAVI is an international multicenter registry of all consecutive TAVRpatients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF. Results: A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP≥40%.After multivariable adjustment, VP≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P=0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P=0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P=0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80- 5.90; P=0.13). Patients with VP ≥40% showed a higher New York Heart Association functional class both at 1 year (P=0.009) and at last available follow-up (P=0.04) and a nonsignificant reduction of left ventricular ejection fraction (P=0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P=0.009).