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Transcatheter aortic valve replacement and cardiac conduction

Satya Shreenivas1, Edward Schloss1, Joseph Choo1

  • 1a The Christ Hospital Heart and Vascular Center , Cincinnati , OH , USA.

Expert Review of Cardiovascular Therapy
|March 27, 2019
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) can cause conduction abnormalities due to cardiac anatomy and procedural factors. Management strategies for these complications lack consensus guidelines, necessitating further research.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Conduction abnormalities are frequent post-transcatheter aortic valve replacement (TAVR).
  • Etiology involves cardiac anatomy, baseline conduction, and procedural variables.
  • Current management lacks standardized consensus guidelines.

Purpose of the Study:

  • To review the incidence, etiology, outcomes, and management of conduction abnormalities after TAVR.
  • To highlight the impact of cardiac anatomy and procedural factors.
  • To discuss the variability in managing new-onset heart block.

Main Methods:

  • Literature review and expert opinion synthesis.
  • Analysis of factors influencing conduction abnormalities post-TAVR.
  • Discussion of current management approaches and outcomes.

Main Results:

  • Conduction abnormalities are significantly influenced by membranous septum length, calcification, and valve implantation depth.
  • Pre-existing right bundle branch block is a predictor of post-TAVR conduction issues.
  • Variability exists in managing new high-grade AV block and left bundle branch block.

Conclusions:

  • Understanding the multifactorial etiology of TAVR-related conduction abnormalities is crucial.
  • Standardized guidelines are needed for consistent management of post-TAVR conduction disturbances.
  • Further research should focus on optimizing TAVR procedures to minimize conduction complications.
Abstract

Keywords:
TAVRcomplete heart blockhigh-grade atrioventricular blockleft bundle branch blockpacemakerright bundle branch block

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