Background: Permanent pacemaker implantation (PPI) and heart conduction disturbances are the most common complications of TAVR. Several predictors of PPI after TAVR have been consistently identified. Objective: This study was aimed to estimate occurrence and detect predictors of permanent pacemaker implantation after trans-catheter aortic valve implantation versus surgical aortic valve replacement. Methods: Prospective cohort study from November 2014 to April 2017 in National Heart Institute and Zagazig University Hospitals in elderly severe symptomatic aortic valve stenosis patients who were candidates for aortic valve replacement. Results: The incidence of AV conduction disorders was significant high in TAVI group compared to SAVR group 50% vs. 20% (p value =0.03) derived mainly by significant increased incidence of LBBB and complete heart block. Permanent pacemaker implantation was done post procedure to three cases in TAVI group and to one case in surgical aortic valve replacement group. After one-month pacemaker implantation was done to another one patient in the TAVI group. Conclusion: Transcatheter aortic valve implantation is significantly followed by incidence of atrio-ventricular conduction disorders mainly the third-degree atrio-ventricular block demanding for permanent pacemaker implantation and left bundle branch block in comparison to surgical aortic valve replacement.