Kept in an extra night "to watch my heart rhythm" after TAVR, does that mean I'm getting a pacemaker?

#1frankm1952(Joined Apr 2026 · 19 posts)July 8, 2026, 9:14 pm

Had my TAVR on Monday and everything went fine, valve is working, groin is sore but ok. Except this morning when I expected to go home the registrar comes round and says they want to keep me another night "just to watch the heart rhythm on the monitor". No real explanation, just that my ECG showed "a bit of a delay" after the procedure.

Now I am sat here with the wires still stuck to my chest imagining the worst. Does watching the rhythm basically mean they are deciding whether to give me a PACEMAKER? Is that a normal thing after this or has something gone wrong with the valve? Nobody used the word pacemaker but the way she said it made my stomach drop.

Anyone been kept the extra night like this? What happened with you.

#2TwoNightsTerry(Joined Feb 2026 · 63 posts)July 9, 2026, 7:52 am

Two nights was exactly my stay and I went home on schedule, no rhythm drama, so I can't speak to the extra night directly. But I remember the monitor being the big thing on the ward, more than the valve. The nurse told me they watch the rhythm because the new valve sits right next to the heart's wiring and it can get grumpy for a few days.

The bit that would reassure me if I were you: "a bit of a delay" on the ECG is not the same as needing a device. Try to sit tight for the answer rather than the imagined version.

#3Ron Castellano(Joined Feb 2026 · 47 posts)July 9, 2026, 2:30 pm

Frank I am the person you are worried about becoming, so let me take the fear out of it. I had the self expanding valve back in March, and on day two the monitor caught my heart pausing longer than they were happy with. They fitted a pacemaker the next morning. Local anaesthetic, I was chatting to the nurse through most of it, home the day after that.

Here is what nobody tells you: it changed nothing about how I feel. The breathlessness the valve fixed is still gone. The pacemaker just sits there quietly under my collarbone doing its job. Four months on I forget it exists except when I get it checked. So even the "bad" outcome you are dreading is genuinely fine to live with.

#4Dr. Helena VossClinical reviewer(Joined Jan 2026 · 58 posts)July 10, 2026, 9:05 am

Frank, being kept an extra night to watch the rhythm is a routine and sensible precaution, not a sign that anything has gone wrong with your valve. Let me give you the direct answer and then what it depends on.

The aortic valve sits directly above the fibres that carry the heart's electrical signal, the bundle of His. When the frame of a TAVR valve expands inside the old valve it can press on those fibres, and "a bit of a delay" on the ECG usually means a new conduction change, most often a new left bundle branch block. That change alone is seen in roughly 20 to 30 percent of patients and very often needs only monitoring, not a device. A permanent pacemaker is needed less often, somewhere around 10 to 20 percent overall, and the rate is higher with self-expanding valves (about 17 percent in the Evolut Low Risk trial) than with balloon-expandable ones (about 6.6 percent in PARTNER 3).

What the decision depends on is what the monitor shows over these days. Most problems that will need a device declare themselves in the first 24 to 48 hours, which is exactly why they keep you on telemetry. If your rhythm stays stable, the wires come off and you go home. If it shows a high-grade block that does not recover, they place the pacemaker before discharge, usually under local anaesthetic, and it becomes a manageable part of the long routine rather than a setback. Ron's account above is a fair picture of that path. The whole subject, including who is most at risk, is laid out in why some patients need a pacemaker after TAVR.

One correction worth making gently: a pacemaker addresses the wiring, never the valve. Your valve working perfectly and your rhythm needing support are two separate things that can sit side by side. Do ask your own team what specifically they saw on your ECG, because they can read your tracing and I cannot.

#5Marlene K(Joined Mar 2026 · 31 posts)July 10, 2026, 6:47 pm

Dr. Helena Voss said:

a pacemaker addresses the wiring, never the valve

This is the thing I got wrong for weeks after my procedure. I assumed if anyone came out with a pacemaker it meant their valve was a dud, and I was quietly smug that mine wasn't. Reading it put plainly like this I feel a bit daft. They really are two separate jobs.

#6frankm1952(Joined Apr 2026 · 19 posts)July 14, 2026, 10:22 am

Update for anyone who finds this later. Rhythm stayed steady through the second night, the delay didn't get any worse, and they took the wires off and sent me home Thursday. No pacemaker. The registrar said the delay might settle on its own and they'll recheck the ECG at my follow up.

Reading Ron's post was honestly what got me through the extra night, because it meant even the outcome I was scared of was one I could live with fine. Thank you all, and Dr Voss, that explanation should be handed out on the ward.