Complete heart block following TAVR: blocking the way forward?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Trans-catheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
• Complete heart block (CHB) and the need for permanent pacemakers (PPM) are known complications post-TAVR.
• Understanding risk factors for CHB after TAVR is crucial for patient management.

Discussion:

• The incidence of CHB and PPM implantation following TAVR is increasing.
• CHB post-TAVR is associated with adverse outcomes, including higher in-hospital mortality, longer hospital stays, and increased costs.
• Right bundle branch block (RBBB) present before TAVR is the most significant independent predictor of developing CHB after the procedure.

Key Insights:

• An upward trend in CHB and PPM rates post-TAVR necessitates careful monitoring.
• CHB following TAVR significantly impacts patient outcomes and healthcare resource utilization.
• Identifying patients with pre-existing RBBB is vital for risk stratification and proactive management strategies.

Outlook:

• Further research should focus on refining TAVR techniques to minimize conduction disturbances.
• Developing predictive models for CHB risk in TAVR candidates could improve patient selection and peri-procedural care.
• Investigating optimal management strategies for patients who develop CHB after TAVR is warranted.