Permanent pacemaker implantation (PPI) is a recognised complication of transcatheter aortic valve replacement (TAVR). PPI rates have generally been higher with self-expanding, as opposed to balloon-expandable, transcatheter heart valves (THVs); and higher yet than surgical aortic valve replacement. The prototypic self-expanding platform is, of course, the CoreValve/Evolut THV device (Medtronic) with its nitinol supra-annular frame anchored both below and above the coronary ostia. Conduction disturbances post TAVR requiring PPI are largely attributable to injury to the atrioventricular conduction system as it passes through the membranous septum below the right coronary cusp. Traumatic injury to the conduction system resulting from catheter manipulation and THV expansion deep within the LVOT are the major factors involved. The importance of conduction system injury and PPI is clear. There are implications with respect to hospital stay, health care resources, and late implications with respect to ventricular function, morbidity and, possibly, mortality.