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2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing

Scott M Lilly, Abhishek J Deshmukh, Andrew E Epstein

    Journal of the American College of Cardiology
    |November 16, 2020
    PubMed

    Insights

    Managing heart conduction issues after transcatheter aortic valve replacement (TAVR) lacks clear guidelines. This expert consensus provides a decision pathway for optimal patient care and pacemaker use post-TAVR.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Electrophysiology

    Background:

    • Cardiac conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR).
    • Lack of high-quality randomized controlled trials and evolving TAVR technology contribute to management challenges.
    • Existing guidelines offer limited detail on pacing strategies post-TAVR.

    Framework:

    • This document proposes an evidence-based expert consensus decision pathway for managing conduction disturbances following TAVR.
    • The pathway integrates current data, clinical experience, and expert opinion to address management gaps.

    Implementation:

    • Reviews existing data and clinical practices for post-TAVR conduction disturbances.
    • Provides a structured approach to decision-making, including observation, electrophysiological testing, and pacemaker implantation.
    • Addresses the interplay between TAVR, valvular heart disease, and cardiovascular implantable electrical devices.

    Implications:

    • Aims to establish best practices for TAVR patient care in the United States.
    • Facilitates standardized and optimized management of conduction disturbances, potentially improving patient outcomes.
    • Guides clinicians in navigating complex decisions regarding pacing in the post-TAVR setting.

    Keywords:
    ACC Expert Consensus Decision Pathwaydelayed high grade atrioventricular blockpermanent pacemakertranscatheter aortic valve replacement

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