Cardiac conduction system disease after transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe calcific aortic stenosis.
• While TAVR reduces risks compared to open surgery, electrophysiologic complications like conduction abnormalities (CAs) persist.
• CAs after TAVR range widely, with up to 33% needing permanent pacemakers.

Purpose of the Study:

• To review current understanding of TAVR-related conduction abnormalities.
• To discuss predictors, mechanisms, and clinical implications of CAs post-TAVR.
• To highlight the need for tools to identify high-risk patients and predict CA course.

Main Methods:

• Review of existing literature on TAVR and conduction abnormalities.
• Analysis of reported rates, predictors, and potential mechanisms of CAs.
• Discussion of clinical outcomes and future research needs.

Main Results:

• Conduction abnormalities (CAs) occur in a significant portion of TAVR patients, with variable rates depending on the prosthesis.
• Mechanical compression of the cardiac conduction system by the TAVR device is the leading hypothesized cause of CAs.
• CAs can manifest acutely or delayed, and may be transient or permanent.

Conclusions:

• Predictors for CAs include device choice, baseline conduction issues, and patient anatomy.
• Currently, no clinical tools exist to reliably identify patients at high risk for CAs or predict their trajectory.
• Further research is essential to identify high-risk patients, minimize electrophysiologic complications, and guide post-TAVR monitoring.