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

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.