T ranscatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with aortic stenosis who are considered to be nonoperable and a good alternative for those at high surgical risk.1 However, the occurrence of some periprocedural complications remains a concern. The need for permanent pacemaker implantation (PPI) after the procedure is one of the most frequent complications associated with TAVI, with an overall incidence of ≈15% (≈25% and 7% after TAVI with self-expandable valves [SEVs] and balloon-expandable valves [BEVs], respectively). 1 Clinical Perspective on p 1243Strong evidence supports the potential negative impact of right ventricular apical pacing, which has been associated with an increased rate of the combined end point of mortality and rehospitalization for heart failure in patients with left ventricular dysfunction, 2-4 ventricular tachyarrhythmias, 5,6 and pacing-induced cardiomyopathy in patients without overt structural heart disease. 7 However, evidence for the clinical impact of PPI after TAVI remains scarce and based on small Background-Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. =0.121). Conclusions-The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death.