Trust in automated vehicles: constructs, psychological processes, and assessment.

There is a growing body of research on trust in driving automation systems. In this paper, we seek to clarify the way trust is conceptualized, calibrated and measured taking into account issues related to specific levels of driving automation. We find that: (1) experience plays a vital role in trust calibration; (2) experience should be measured not just in terms of distance traveled, but in terms of the range of situations encountered; (3) system malfunctions and recovery from such malfunctions is a fundamental part of this experience. We summarize our findings in a framework describing the dynamics of trust calibration. We observe that methods used to quantify trust often lack objectivity, reliability, and validity, and propose a set of recommendations for researchers seeking to select suitable trust measures for their studies. In conclusion, we argue that the safe deployment of current and future automated vehicles depends on drivers developing appropriate levels of trust. Given the potentially severe consequences of miscalibrated trust, it is essential that drivers incorporate the possibility of new and unexpected driving situations in their mental models of system capabilities. It is vitally important that we develop methods that contribute to this goal.

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly-results of a retrospective multi-center study.

Introduction: While in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare. Methods: We included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes. Results: Patients with CTIA showed a significant increase in LVEF after 1 (p < 0.001) and 2 years (p < 0.001) in contrast to baseline LVEF. Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality (p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044-7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013). Conclusions: CTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization.

Case report: Short-long-short mechanism triggering sustained ventricular tachycardia in a patient with a single-chamber ICD but inhibiting antitachycardia therapy.

Introduction: Short-long-short (SLS) sequences are an important cause of ICD pro-arrhythmia and can initiate both polymorphic and monomorphic ventricular tachycardias (VT). Depending on the programming of a single-chamber ICD, the interplay between SLS sequences and combined VT detection criteria can be responsible for withholding adequate anti-tachycardia pacing (ATP) or shock therapy. Methods: A 78-year-old patient with ICD was admitted to our emergency department after external cardioversion of a long-lasting VT with hemodynamic compromise. The interrogation of the ICD revealed an SLS sequence initiating a monomorphic VT at a rate of 171 bpm (350 ms). The VT discrimination of the implanted single-chamber ICD was based on the onset and stability criteria as the patient had a history of paroxysmal atrial fibrillation. The ICD was programmed that both criteria had to be met for VT detection and initiation of anti-tachycardia therapy. Results: Due to the SLS sequence in combination with the programmed VT detection interval, the onset threshold was not fulfilled and inhibited adequate therapy. Some relatively slow VT beats following the SLS sequence resulted finally in a considerable delay in the declaration of the episode onset. As a first step, the threshold for VT detection was programmed to 150 instead of 160 bpm. To avoid SLS sequences and pause-dependent ventricular tachyarrhythmias, VVI backup stimulation was increased from 35 to 55 ppm. Besides, a device-specific algorithm called rate smoothing was activated as a potential preventive feature. On the 3-month follow-up, all sustained VT episodes were detected adequately by the reprogrammed device, resulting in appropriate anti-tachycardia pacing. After further refinement and less aggressive programming of rate smoothing, the patient remained free of symptoms and arrhythmias over a follow-up of more than 2.5 years, particularly since progression to permanent atrial fibrillation and pacing at a lower rate of 60 ppm. Conclusions: SLS sequences may initiate or trigger VT episodes. Misclassification of the true onset may occur in some ICD devices due to specific programming of VT detection criteria. If both criteria "Onset and Stability" have to be fulfilled, ICD therapy is not delivered despite ongoing VT. Anti-bradycardia backup pacing at a very low stimulation rate may facilitate SLS sequences in patients with ICD resembling a potential pro-arrhythmic mechanism. In case of gradual VT onset with some intervals slower than the programmed VT threshold, the detection rate has to be adjusted down to guarantee appropriate identification of the onset.

Implicit intention communication as a design opportunity for automated vehicles: Understanding drivers' interpretation of vehicle trajectory at narrow passages.

To ensure road safety in mixed traffic, automated vehicles (AVs) must be equipped with distinct and easy-to-understand communication strategies. For this, the communication design of AVs might be oriented toward implicit communication between manually driven vehicles. This research focused on how drivers interpret observable vehicle behavior (vehicle trajectory) to predict vehicle intentions and planned maneuvers. In addition, the processing and interpretation of contradictory cues were examined as a possible cause for misunderstandings and failed coordination. Two video-based experiments investigated the presumed intention (yielding or insisting on priority), intention recognition time, distinctiveness, and cooperativeness of a vehicle's implicit communication at narrow road passages. For this, two vehicles approached a bottleneck from opposite sides, and only one vehicle could pass at a time. The driving behavior of the oncoming vehicle consisted of longitudinal (decelerating, stopping, accelerating, maintaining speed) and lateral movements (driving to the center, driving to the edge of the road, no lateral deviation) at different timings (early, late). The results indicated advantages of lateral vehicle movements for distinct intention communication. Lateral movements were interpreted the fastest, perceived more distinct, and were more decisive for the presumed intention than longitudinal movements. Early communication was preferred by drivers but increased the intention recognition time, especially for longitudinal movements. However, early lateral communication was interpreted as fast as late longitudinal communication. Furthermore, lateral and longitudinal vehicle movements within a driving pattern that contradicted each other led to ambiguous perceptions. For AVs, early distinct communication via lateral vehicle movement is recommended. Minimizing ambiguity in the interpretation of communication cues might maximize the probability of the safest response from human drivers and contribute to accident prevention in mixed traffic.

Gender-Specific Differences in the Intensive Care Treatment of COVID-19 Patients.

BACKGROUND: Gender-specific differences in the outcome of COVID-19 patients requiring intensive care treatment have been reported. However, a potential association with ICU therapy remains elusive. METHODS: A total of 224 consecutive patients (63 women) treated for severe COVID-19 disease requiring mechanical ventilation were screened for the study. After propensity score matching for gender, 40 men and 40 women were included in the study. Comparative analysis was conducted for laboratory parameters, ICU therapy and complications (pulmonary embolism, thrombosis, stroke, and ventricular arrhythmias), and outcome (mortality). RESULTS: Male patients had significantly higher levels of CRP (p = 0.012), interleukin-6 (p = 0.020) and creatinine (p = 0.027), while pH levels (p = 0.014) were significantly lower compared to females. Male patients had longer intubation times (p = 0.017), longer ICU stays (p = 0.022) and higher rates of catecholamine dependence (p = 0.037). Outcome, complications and ICU therapy did not differ significantly between both groups. CONCLUSION: The present study represents the first matched comparison of male and female COVID-19 patients requiring intensive care treatment. After propensity matching, male patients still displayed a higher disease severity. This was reflected in higher rates of vasopressors, duration of ICU stay and duration of intubation. In contrast, no significant differences were observed in mortality rates, organ replacement therapy and complications during ICU stay.

ARGOS: An adaptive refinement goal-oriented solver for the linearized Poisson-Boltzmann equation.

An adaptive finite element solver for the numerical calculation of the electrostatic coupling between molecules in a solvent environment is developed and tested. At the heart of the solver is a goal-oriented a posteriori error estimate for the electrostatic coupling, derived and implemented in the present work, that gives rise to an orders of magnitude improved precision and a shorter computational time as compared to standard finite difference solvers. The accuracy of the new solver ARGOS is evaluated by numerical experiments on a series of problems with analytically known solutions. In addition, the solver is used to calculate electrostatic couplings between two chromophores, linked to polyproline helices of different lengths and between the spike protein of SARS-CoV-2 and the ACE2 receptor. All the calculations are repeated by using the well-known finite difference solvers MEAD and APBS, revealing the advantages of the present finite element solver.

Management of Implantable Cardioverter-Defibrillators during Pregnancy-A Systematic Review.

BACKGROUND: With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available. METHODS: To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports). RESULTS: According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population. CONCLUSIONS: Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers.

More Than a Feeling-Interrelation of Trust Layers in Human-Robot Interaction and the Role of User Dispositions and State Anxiety.

With service robots becoming more ubiquitous in social life, interaction design needs to adapt to novice users and the associated uncertainty in the first encounter with this technology in new emerging environments. Trust in robots is an essential psychological prerequisite to achieve safe and convenient cooperation between users and robots. This research focuses on psychological processes in which user dispositions and states affect trust in robots, which in turn is expected to impact the behavior and reactions in the interaction with robotic systems. In a laboratory experiment, the influence of propensity to trust in automation and negative attitudes toward robots on state anxiety, trust, and comfort distance toward a robot were explored. Participants were approached by a humanoid domestic robot two times and indicated their comfort distance and trust. The results favor the differentiation and interdependence of dispositional, initial, and dynamic learned trust layers. A mediation from the propensity to trust to initial learned trust by state anxiety provides an insight into the psychological processes through which personality traits might affect interindividual outcomes in human-robot interaction (HRI). The findings underline the meaningfulness of user characteristics as predictors for the initial approach to robots and the importance of considering users' individual learning history regarding technology and robots in particular.

Upstream Statin Therapy and Long-Term Recurrence of Atrial Fibrillation after Cardioversion: A Propensity-Matched Analysis.

The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients (n = 454) undergoing CV. Cox regression models were performed to estimate AF recurrence comparing patients with and without statins. In addition, we performed a propensity score matched analysis with a 1:1 ratio. Statins were prescribed to 183 (40.3%) patients. After a median follow-up period of 373 (207-805) days, recurrence of AF was present in 150 (33.0%) patients. Patients receiving statins had a significantly lower rate of AF recurrence (log-rank p < 0.001). In univariate analysis, statin therapy was associated with a significantly reduced rate of AF recurrence (HR 0.333 (95% CI 0.225-0.493), p = 0.001), which remained significant after adjustment (HR 0.238 (95% CI 0.151-0.375), p < 0.001). After propensity score matching treatment with statins resulted in an absolute risk reduction of 27.5% for recurrent AF (21 (18.1%) vs. 53 (45.7%); p < 0.001). Statin therapy was associated with a reduced risk of long-term AF recurrence after successful cardioversion.

What's Driving Me? Exploration and Validation of a Hierarchical Personality Model for Trust in Automated Driving.

OBJECTIVE: This paper presents a comprehensive investigation of personality traits related to trust in automated vehicles. A hierarchical personality model based on Mowen's (2000) 3M model is explored in a first and replicated in a second study. BACKGROUND: Trust in automation is established in a complex psychological process involving user-, system- and situation-related variables. In this process, personality traits have been viewed as an important source of variance. METHOD: Dispositional variables on three levels were included in an exploratory, hierarchical personality model (full model) of dynamic learned trust in automation, which was refined on the basis of structural equation modeling carried out in Study 1 (final model). Study 2 replicated the final model in an independent sample. RESULTS: In both studies, the personality model showed a good fit and explained a large proportion of variance in trust in automation. The combined evidence supports the role of extraversion, neuroticism, and self-esteem at the elemental level; affinity for technology and dispositional interpersonal trust at the situational level; and propensity to trust in automation and a priori acceptability of automated driving at the surface level in the prediction of trust in automation. CONCLUSION: Findings confirm that personality plays a substantial role in trust formation and provide evidence of the involvement of user dispositions not previously investigated in relation to trust in automation: self-esteem, dispositional interpersonal trust, and affinity for technology. APPLICATION: Implications for personalization of information campaigns, driver training, and user interfaces for trust calibration in automated driving are discussed.

Infective endocarditis - A review of current therapy and future challenges.

Etiological, microbiological and epidemiological factors changed over time, but mortality rates remain high in infective endocarditis (IE). Healthcare-associated IE is nowadays responsible for a significant proportion of cases due to increasing numbers of cardiac devices. Cardiac implantable electronic devices, transcatheter aortic valve replacement, and percutaneous valve repair are meanwhile used, especially in old and sick patients. In suspected IE modified Duke criteria, integrating clinical results, imaging, and biomarkers are traditionally applied. Newer imaging technologies such as multi-slice computed tomography, photon-emission computed tomography, and magnetic resonance imaging might add value to conventional echocardiography in diagnosis and management of IE. Treatment consists of long-term antibiotic therapy, infectiological source control and/or cardiac surgery. Recently, antibiotic parenteral outpatient regimens and partial oral treatment strategies were shown to shorten hospital stays in patients suffering from IE. However, it remains unclear how to best select patients for partial oral therapy. This review describes new trends in diagnosing, imaging, and treating IE in a changing patient collective with particular focus on patients with implantable cardiac devices.

Exercise-related T-wave oversensing: an underestimated cause of reduced exercise capacity in a pacemaker-dependent patient-a case report and review of the literature.

A 62-year-old pacemaker-dependent patient presented to our department with a sudden onset of reduced physical capacity. While initial physical and pacemaker evaluations remained without specific findings, Holter-ECG monitoring revealed an abnormal rate response with unusual pauses during physical exercise. Consequently, closer evaluation of the pacemaker system revealed intermittent, exercise-related T-wave oversensing (TWOS). While TWOS remains a significant burden in ICD-patients, it might be an underestimated but clinically significant event in pacemaker patients. Further studies should evaluate the impact of TWOS in this patient population.

Development and Testing of Psychological Conflict Resolution Strategies for Assertive Robots to Resolve Human-Robot Goal Conflict.

As service robots become increasingly autonomous and follow their own task-related goals, human-robot conflicts seem inevitable, especially in shared spaces. Goal conflicts can arise from simple trajectory planning to complex task prioritization. For successful human-robot goal-conflict resolution, humans and robots need to negotiate their goals and priorities. For this, the robot might be equipped with effective conflict resolution strategies to be assertive and effective but similarly accepted by the user. In this paper, conflict resolution strategies for service robots (public cleaning robot, home assistant robot) are developed by transferring psychological concepts (e.g., negotiation, cooperation) to HRI. Altogether, fifteen strategies were grouped by the expected affective outcome (positive, neutral, negative). In two online experiments, the acceptability of and compliance with these conflict resolution strategies were tested with humanoid and mechanic robots in two application contexts (public: n 1 = 61; private: n 2 = 93). To obtain a comparative value, the strategies were also applied by a human. As additional outcomes trust, fear, arousal, and valence, as well as perceived politeness of the agent were assessed. The positive/neutral strategies were found to be more acceptable and effective than negative strategies. Some negative strategies (i.e., threat, command) even led to reactance and fear. Some strategies were only positively evaluated and effective for certain agents (human or robot) or only acceptable in one of the two application contexts (i.e., approach, empathy). Influences on strategy acceptance and compliance in the public context could be found: acceptance was predicted by politeness and trust. Compliance was predicted by interpersonal power. Taken together, psychological conflict resolution strategies can be applied in HRI to enhance robot task effectiveness. If applied robot-specifically and context-sensitively they are accepted by the user. The contribution of this paper is twofold: conflict resolution strategies based on Human Factors and Social Psychology are introduced and empirically evaluated in two online studies for two application contexts. Influencing factors and requirements for the acceptance and effectiveness of robot assertiveness are discussed.

The More You Know: Trust Dynamics and Calibration in Highly Automated Driving and the Effects of Take-Overs, System Malfunction, and System Transparency.

OBJECTIVE: This paper presents a theoretical model and two simulator studies on the psychological processes during early trust calibration in automated vehicles. BACKGROUND: The positive outcomes of automation can only reach their full potential if a calibrated level of trust is achieved. In this process, information on system capabilities and limitations plays a crucial role. METHOD: In two simulator experiments, trust was repeatedly measured during an automated drive. In Study 1, all participants in a two-group experiment experienced a system-initiated take-over, and the occurrence of a system malfunction was manipulated. In Study 2 in a 2 × 2 between-subject design, system transparency was manipulated as an additional factor. RESULTS: Trust was found to increase during the first interactions progressively. In Study 1, take-overs led to a temporary decrease in trust, as did malfunctions in both studies. Interestingly, trust was reestablished in the course of interaction for take-overs and malfunctions. In Study 2, the high transparency condition did not show a temporary decline in trust after a malfunction. CONCLUSION: Trust is calibrated along provided information prior to and during the initial drive with an automated vehicle. The experience of take-overs and malfunctions leads to a temporary decline in trust that was recovered in the course of error-free interaction. The temporary decrease can be prevented by providing transparent information prior to system interaction. APPLICATION: Transparency, also about potential limitations of the system, plays an important role in this process and should be considered in the design of tutorials and human-machine interaction (HMI) concepts of automated vehicles.

Potential mechanisms of endothelialisation in individuals implanted with a leadless pacemaker systems: An experimental in vitro study.

BACKGROUND: Leadless pacemaker technology is a promising upcoming field in clinical rhythmology. Today, the most commonly used system in the clinical setting is the Micra™ leadless pacemaker system (Medtronic). In autopsies of patients who witnessed non-pacemaker associated death, unexpected ingrowth/encapsulation within the wall of the right ventricle was reported. The occurrence of a complete encapsulation was not expected and the process of endothelialisation remains unclear. We hypothesized, that a local inflammatory response might be the cause of these findings. The aim of our experimental in-vitro study was to investigate the effect of the Micra™ system and its single components on inflammatory processes. METHODS: For this purpose, whole Micra™ pacemakers were incubated in heparin plasma from 25 healthy volunteers for 48 h at 37 °C. Furthermore, 1 g gold, steel, titanium, tungsten and nitinol wires were incubated in heparin plasma for 48 h at 37 °C as well (n = 10). To detect eventual inflammatory processes, interleukin- (IL) 1ß, IL-6, and tumor necrosis factor alpha (TNF-α), the chemokine IL-8 were measured using enzyme-linked immunosorbent assay (ELISA). Additionally, the level of transforming growth factor beta 1 (TGF-ß1) and vascular endothelial growth factor (VEGF) were analysed. RESULTS: ELISA analyses showed that the whole Micra system leads to a significant increase in the inflammatory cytokine IL-6 which correlates with the data gained by the incubation of whole blood with the different wires. In particular, 0.5 g of tungsten showed a significant rise of IL-6 which could also be found for IL-1ß and IL-8. CONCLUSIONS: The in vitro study of the Micra system showed that the material composition led to an onset of inflammatory processes in whole blood. Consequently, one may speculate that the composition of Micra pacemaker may have a local inflammatory, though subclinical, effects in patients implanted with a Micra™ pacemakers.

Scared to Trust? - Predicting Trust in Highly Automated Driving by Depressiveness, Negative Self-Evaluations and State Anxiety.

The advantages of automated driving can only come fully into play if these systems are used in an appropriate way, which means that they are neither used in situations they are not designed for (misuse) nor used in a too restricted manner (disuse). Trust in automation has been found to be an essential psychological basis for appropriate interaction with automated systems. Well-balanced system use requires a calibrated level of trust in correspondence with the actual ability of an automated system. As for these far-reaching implications of trust for safe and efficient system use, the psychological processes, in which trust is dynamically calibrated prior and during the use of automated technology, need to be understood. At this point, only a restricted body of research investigated the role of personality and emotional states for the formation of trust in automated systems. In this research, the role of the personality variables depressiveness, self-efficacy, self-esteem, and locus of control for the experience of anxiety before the first experience with a highly automated driving system were investigated. Additionally, the relationship of the investigated personality variables and anxiety to subsequent formation of trust in automation was investigated. In a driving simulator study, personality variables and anxiety were measured before the interaction with an automated system. Trust in the system was measured after participants drove with the system for a while. Trust in the system was significantly predicted by state anxiety and the personality characteristics self-esteem and self-efficacy. The relationships of self-esteem and self-efficacy were mediated by state anxiety as supported by significant specific indirect effects. While for depression the direct relationship with trust in automation was not found to be significant, an indirect effect through the experience of anxiety was supported. Locus of control did not show a significant association to trust in automation. The reported findings support the importance of considering individual differences in negative self-evaluations and anxiety when being introduced to a new automated system for individual differences in trust in automation. Implications for future research as well as implications for the design of automated technology in general and automated driving systems are discussed.

A comparative analysis of novel cardiovascular biomarkers in patients with chronic heart failure.

BACKGROUND: Heart failure (HF) with reduced ejection fraction remains a major therapeutic challenge. The aim of this study was to investigate the role of novel cardiovascular biomarkers, i.e. soluble suppression of tumorigenicity (sST2), growth-differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR) and heart-type fatty acid binding protein (H-FABP) in patients with ischaemic (ICM) or dilative cardiomyopathy (DCM). MATERIALS AND METHODS: A total of 200 patients were enrolled in this study: 65 were diagnosed with DCM and 59 patients suffering from ICM were included. 76 patients without coronary artery disease or signs of heart failure were included as controls. Plasma samples of all patients were analyzed by use of ELISA. RESULTS: Levels of sST2, suPAR and H-FABP were significantly higher in ICM and DCM patients compared to the control group (p<0.0001). However, there were no significant differences between ICM and DCM in biomarker levels. Ejection fraction correlated inversely with cardiac biomarkers (sST2 p<0.0001, GDF-15 p=0.0394, suPAR p=0.0029, H-FABP p<0.0001). Similarly, CRP levels also showed a positive correlation with cardiac biomarkers. Renal insufficiency (p<0.0001) and diabetes (sST2 p=0.0021, GDF-15 p=0.0055, suPAR p=0.0339, H-FABP p=0.0010) were significantly associated with a rise in cardiac biomarkers. CONCLUSION: Novel cardiovascular biomarkers such as ST2, GDF-15, uPAR and H-FABP could offer a great potential for more precise diagnostic in ICM and DCM patients. H-FABP was the most promising marker in our study, followed by sST2, uPAR and GDF-15. Additional prospective studies will be necessary to further evaluate the potential clinical benefits in routine treatment of HF.

Short-term pacemaker dependency after transcatheter aortic valve implantation.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a less invasive technique for the treatment of severe aortic stenosis in high-risk patients. Occurrence of conduction disturbances requiring permanent pacemaker (PPM) implantation after TAVI is frequently observed. METHODS: The retrospective analysis comprised 153 patients (96 women, aged from 65 to 97 years) who underwent TAVI due to high-grade aortic stenosis. The aim was to evaluate the incidence of high-grade atrioventricular (AV) block after TAVI and the percentage of ventricular pacing and pacemaker (PM)-dependency at the first follow-up 6-8 weeks after implantation. RESULTS: Out of the 153 patients (age 81 ± 6 years) who underwent TAVI, 144 (94 %) had a transfemoral and 9 (6 %) patients a transapical approach. A PPM was implanted in 31 (20 %) patients, 24 (16 %) were implanted with the Medtronic CoreValve® and 7 (5 %) with the Edwards Sapien® valve (p = n.s.). Complete AV block was the indication in 21 patients (68 %), second-degree AV block in 1 patient (3 %), slow atrial fibrillation in 3 patients (10 %), new left bundle branch block (LBBB) plus sustained ventricular tachycardia (VT) in 1 patient (3 %), sick sinus syndrome in 2 patients (7 %), whereas in 3 patients (10 %) a PPM was inserted for safety reasons because of new LBBB and first-grade AV block. All of the nine patients (6 %) with a preexisting bundle branch block developed total AV block after TAVI. At follow-up PM-dependency (intrinsic rhythm < 30 bpm) occurred in 11/30 patients (37 %), whereas an intrinsic rhythm > 50 bpm was seen in 17 patients (57 %). At nominal device programming the percentage of ventricular stimulation (VP) during the short-term observation period was 60 ± 44 % in dual-chamber devices (N = 18), and 70 ± 36 % in single-chamber PPM (N = 5). CONCLUSION: The PPM implantation rate of about 20 % after TAVI is comparable to previously published data. The need for permanent pacing is linked to the valve type and preexistence of a right bundle branch block. At short-term more than half of the patients implanted with a device were not strictly PM-dependent, but presented an underlying intrinsic rhythm, indicating that temporary AV conduction disturbances may recover over time. This might justify a more conservative approach in some patients under watchful waiting. From another point of view, ventricular pacing at a regular or sensor-modulated rate may provide rhythm stability and chronotropy during the short-term period post-TAVI.