Background <p>Transcatheter aortic valve implantation (TAVI) is a standard minimally invasive treatment for high-risk patients with severe aortic valve disease. However, the safety of permanent pacemaker implantation (PPI) following TAVI under multiple antithrombotic regimens remains inadequately studied.</p> Methods <p>In this single-center retrospective study, 203 patients who underwent TAVI between January 2021 and May 2025 were included. Based on post-TAVI PPI status, patients were categorized into pacemaker (PM, <i>n</i> = 35) and non-pacemaker (NPM, <i>n</i> = 168) groups. Each group was further stratified by antithrombotic regimen (mono-[MA], dual-[DA], or triple-antithrombotic [TA] therapy). Outcomes, including pocket hematoma, thromboembolic events, and infections, were assessed over a three-month follow-up period.</p> Results <p>No significant differences in baseline characteristics were observed between the PM and NPM groups. In the PM group, one death occurred in the TA subgroup. Pocket hematoma and major bleeding each occurred in one patient in the TA subgroup, and lead dislodgement occurred in one patient in the DA subgroup. No significant differences in complication rates were found among antithrombotic subgroups (<i>P</i> &gt; 0.05). The use of optimized hemostatic techniques—including electrocautery, hemostatic sponges, and compressive bandaging—was associated with low overall hematoma and infection rates.</p> Conclusion <p>PPI following TAVI appears safe under various antithrombotic therapies when accompanied by meticulous hemostatic management. Individualized antithrombotic strategies and standardized perioperative techniques may mitigate bleeding and thrombotic risks in this high-risk population.</p>