Limitations:
Multiple noteworthy limitations exist in our study. Due to inherent administrative nature of this database, coding errors could result in identification of comorbidities as well as procedures. The database lacks the procedural characteristics of the TAVR (type and size of valve) as well as the lack of post-procedural complications. The extent of baseline electrocardiographic findings (QRS duration, PR interval) is limited. Post-discharge follow-up and use of ambulatory monitoring remains unknown, which could influence the timing of pacemaker implantation. It is possible that some patients may have died unexpectedly during the initial months post TAVR before they could reach the hospital. This could underestimate the true incidence of conduction system abnormalities. We purposefully excluded defibrillator implantation as well as CRT implantation in both index as well as follow-up patients in order to avoid any confusion regarding indication for implantation in late follow-up. However, given these limitations, the large sample size of the NRD database makes it optimal for capturing the small but significant increase in pacemaker implantations after discharge.