We have read with interest the letter by Rodríguez-Olivares et al. regarding our article “Conduction Abnormalities and Pacemaker Implantations After SAPIEN 3 Vs SAPIEN XT Prosthesis Aortic Valve Implantation”.1 The authors point out that discussion of the clinical impact of the study lacked 2 features: depth of implantation and exclusion of patients with preprocedural right bundle branch block.

While it is true that in the present article, and stated in the limitations section, we did not include and analyze the issue of implantation depth on the incidence of permanent pacemaker implantation (PPI) or new onset conduction abnormalities, we kindly direct attention toward the fact that information of preexistent conduction abnormalities and the association with PPI were indeed included in our article. For the analysis of new PPIs after transcatheter aortic valve implantation, only patients with a previous pacemaker were excluded. We found that patients requiring PPI had less normal conduction, more complete right bundle branch blocks, and a longer QRS interval at baseline (see Results section of our article).1 In the discussion, we cite the meta-analysis regarding the importance of pre-existing complete right bundle branch blocks for PPI after transcatheter aortic valve implantation.

In conclusion, we regard our article as an initial experience and further research on potential underlying mechanisms and possible strategies to reduce the incidence of PPI with transcatheter aortic valve implantation using novel devices are clearly warranted. Additionally, we completely agree with Rodríguez-Olivares et al. that the issue of “device-host-interaction” is highly important and that there may not be one transcatheter heart valve fitting all patients.