Influence of The Cusp-Overlap and three cusps coplanar techniques on new-onset conduction disturbances following transcatheter aortic valve implantation.

New-onset conduction disturbances (NOCD) including high-degree atrioventricular block (HAVB), permanent pacemaker implantation (PPI) and new-onset left bundle branch block after transcatheter aortic valve implantation (TAVI) remain common and are influenced by implantation depth (ID) relative to patient-specific anatomy, particularly membranous septum length.To compare the cusp-overlap (COL) and conventional three-cusp coplanar (TCC) projection techniques with a focus on ID relative to membranous septum length and its association with conduction outcomes. A total of 501 patients undergoing TAVI with pre-procedural multidetector computed tomography were included. The primary endpoint was a composite of HAVB or PPI at 30 days. ID was measured on the final angiography. Propensity score overlap weighting analysis was performed to assess the effects of COL on ID and the main outcome.COL was significantly associated with higher valve implantation (ID 4.0 ± 1.95 mm vs. 5.54 ± 2.6 mm; β coefficient = -1.76; 95% CI: -2.24 to -1.26). The primary endpoint occurred at similar rates in both groups (15% vs. 19%; p = 0.24), and COL was not independently associated with the primary outcome (OR 0.63, 95% CI 0.36–1.12). Deeper implantation was associated with the primary outcome (4.66 ± 2.33 mm vs. 6.56 ± 2.66 mm; p < 0.01). A greater difference between membranous septum length and ID independently predicted lower event risk.COL was not independently associated with reduced NOCD but may facilitate higher implantation relative to membranous septum length, supporting an individualized, anatomy-guided implantation strategy.