Related Experiment Video

Updated: Nov 6, 2025

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
06:57

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

Published on: January 31, 2019

15.0K

Validation of the 2019 Expert Consensus Algorithm for the Management of Conduction Disturbances After TAVR

Daniel Malebranche1, Joanna Bartkowiak2, Christoph Ryffel2

  • 1Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland; Dalhousie University and Queen Elizabeth II Health Sciences Centre and NS Health Authority, Halifax, Nova Scotia, Canada.

JACC. Cardiovascular Interventions
|May 7, 2021
PubMed

Insights

The 2019 consensus algorithm effectively identifies low-risk patients for early discharge after transcatheter aortic valve replacement (TAVR). However, it is less precise in identifying high-risk patients needing pacemakers.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Optimal management of conduction disturbances post-TAVR remains unclear.
  • A 2019 expert consensus algorithm was developed to guide management.
  • This study validates the algorithm in a contemporary TAVR cohort.

Purpose of the Study:

  • To validate the 2019 consensus algorithm for predicting pacemaker needs post-TAVR.
  • To assess the algorithm's accuracy in stratifying patients for early discharge versus higher risk of heart block.

Main Methods:

  • Retrospective analysis of a prospective registry of 1,439 TAVR patients (Jan 2014 - Dec 2019).
  • Patients classified using the 2019 algorithm: early discharge, higher risk for heart block, or need for pacemaker.
  • Primary endpoint: 30-day pacemaker implantation for high-degree atrioventricular block or complete heart block.

Main Results:

  • The algorithm classified 73% for early discharge, 21% at higher risk, and 6% needing a pacemaker.
  • 16% of patients (234/1,439) received a pacemaker within 30 days.
  • Pacemaker rates: 2.7% (early discharge), 41% (higher risk), 100% (pacemaker group).

Conclusions:

  • The 2019 algorithm safely identifies low-risk TAVR patients eligible for early discharge.
  • It enables uniform management and facilitates early discharge for ~73% of patients.
  • The algorithm demonstrates lower precision in identifying high-risk patients requiring pacemakers.
Abstract

Keywords:
ECG algorithmconduction disturbancespacemaker implantationtranscatheter aortic valve replacement

More Related Videos

Author Spotlight: Improving Lesion Contiguity in Pulmonary Vein Isolation via Proactive Esophageal Cooling05:43

Author Spotlight: Improving Lesion Contiguity in Pulmonary Vein Isolation via Proactive Esophageal Cooling

Published on: April 19, 2024

1.2K
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation06:04

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

318

Related Concept Videos

Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
189
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
71
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
117
Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
81
Cardiac Catheterization IV: Nursing Management01:26

Cardiac Catheterization IV: Nursing Management

Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
337
Dysrhythmias II: Classification of Tachyarrhythmias01:28

Dysrhythmias II: Classification of Tachyarrhythmias

Tachyarrhythmias are a type of dysrhythmia where the heart rate exceeds 100 beats per minute. Here are some common types of tachyarrhythmias:Sinus TachycardiaSinus tachycardia originates from increased impulses from the sinus node, leading to an elevated heart rate. It is often triggered by stress, fever, or exercise.Patients may experience palpitations, a sensation of a racing heart, dizziness, and chest discomfort.Causes and Risk Factors: Common causes include physical exertion, emotional...
275