In a retrospective study, 617 patients who had received transcatheter aortic valve replacement (TAVR) were analyzed to identify novel CT imaging biomarkers, to be used in combination with clinical parameters, for predicting the need for permanent pacemaker (PPM) implantation. The patient cohort was divided into two groups: those who required PPM implantation after TAVR (n=312) and those who did not (n=305). Analysis of the preprocedural contrast-enhanced CT scans revealed that the angle between the ventricle axis and aortic root may serve as a novel imaging predictor. Incorporating this biomarker into existing predictive models based on clinical parameters could improve accuracy in identifying patients at risk, potentially reducing the incidence of malignant arrhythmias and associated mortality.