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Introduction Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis across a range of risk profiles. Despite advances in valve technology and procedural technique, conduction disturbance remains a common complication, with some patients requiring permanent pacemaker (PPM) implantation post procedure. Identification of predictors of PPM insertion informs procedural planning, patient counselling, and post-discharge monitoring.Methods Patients who underwent TAVI at St. James’s hospital between 01/01/2019 and 31/12/2024 were included in a retrospective analysis. Primary outcome was new PPM insertion within 30 days post-TAVI. Patient demographics, baseline and post-TAVI ECG findings and procedural characteristics were recorded. Categorical variables were analysed using Chi-square or Fisher’s exact test, while continuous variables were assessed using independent samples t-tests. A p-value <0.05 was considered statistically significant.Results Of the patients (n=592), 9.8% (n=58) underwent PPM insertion within 30 days and there was no significant variation in implant rates over the study period ( figure 1). PPM requirement was associated with pre-existing RBBB (p=.028), male sex (p=.014). Patients who received larger valves (≥27 mm) had a significantly higher rate of new pacemaker implantation compared to those with smaller valves (47.3% vs. 29.6%, p=.019). Post-TAVI ECG changes were strong predictors, including 3rd-degree AV block (p<.001), 2nd-degree AV block (p<.001), and 1st-degree AV block (p=.004), while the absence of new ECG changes was protective (p<0.001)(table 1). Of the 592 patients, 468 (79.7%) received balloon-expandable valves, with no significant difference in PPM rates between valve types (p=0.187).Conclusion Among our cohort, incidence of new PPM insertion within 30 days post-TAVI was 9.8%. As expected, PPM requirement was strongly associated with new post-TAVI conduction disturbances, particularly high-grade AV block. Pre-existing RBBB, larger valve size and male sex were also associated with PPM insertion. These findings may help identify high-risk patients and guide monitoring strategies post-TAVI.Abstract 65 Table 1Clinical and procedural variables associated with post-TAVI PPM insertion Variable Pacemaker group (N=58) No pacemaker group (N=534) p-value Post-TAVI: 2nd-degree AV block 13.8% 1.5% <.001 Post-TAVI: 3rd-degree AV block 39.7% 1.5% <.001 Post-TAVI: 1st-degree AV block 19.0% 6.9% .004 Post-TAVI: New RBBB 10.3% 3.2% .065 Valve size group – Small (≤23mm ) 20.0% 33.1% Valve size group – Medium (24– 26mm ) 32.7% 37.3% Valve size group – Large (≥27mm ) 47.3% 29.6% 0.019 Post-TAVI: No ECG change 10.3% 52.8% <.001 Age at time of TAVI 81.4 years 80 years .116 Post-dilatation 17.2% 24.9% .202 Device type (balloon-expandable) 63.8% 69.3% .187 Pre-TAVI 1st-degree AV block 6.9% 4.9% .299 Pre-TAVI LBBB 3.4% 5.6% .639 Pre-TAVI RBBB 22.4% 10.3% .028 Post-TAVI: New LBBB 6.9% 7.5% .831 Abbreviations: TAVI: Transcatheter aortic valve implantation; AV: Atrioventricular; RBBB: Right Bundle Branch Block; LBBB: Left Bundle Branch Block.Abstract 65 Figure 1Dual-axis line and bar graph showing TAVI and PPM procedure volumes (bars) with corresponding ppm insertion (line graph)