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Updated: Sep 4, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Long-Term Ventricular Pacing Dependency and Pacemaker Implantation Predictors after Transcatheter Aortic Valve
Ricardo Alves Pinto1, Tânia Proença1, Miguel Martins Carvalho1
1Departamento de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto - Portugal.
Insights
Transcatheter aortic valve replacement (TAVR) frequently causes conduction disturbances (CD). Right bundle branch block (RBBB) is a key predictor of advanced atrioventricular block and permanent pacemaker implantation post-TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Conduction disturbances (CD) are the most common complication following transcatheter aortic valve replacement (TAVR).
- Current management strategies for post-TAVR conduction disturbances lack consensus.
- Understanding risk factors and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the incidence of new conduction disturbances and permanent pacemaker (PPM) implantation after TAVR.
- To assess the ventricular pacing percentage (VP) up to one year post-TAVR.
- To identify predictors of conduction disturbances and PPM implantation.
Main Methods:
- Retrospective analysis of 340 patients undergoing TAVR (October 2014 - November 2019).
- Exclusion of patients with prior PPM implantation.
- Collection of clinical, procedural, ECG, and PPM data up to one year post-procedure.
Main Results:
- Left bundle branch block (LBBB) was the most frequent CD (32.2%), with 56% resolving within six months.
- Right bundle branch block (RBBB) significantly increased the risk of advanced atrioventricular block (AVB) and PPM implantation (OR=8.46 and OR=5.18, respectively).
- 18.5% of patients received a PPM post-TAVR; advanced AVB correlated with higher VP at one year.
Conclusions:
- LBBB is common post-TAVR but often transient.
- RBBB is a critical risk factor for advanced AVB and subsequent PPM implantation.
- Higher VP in patients with advanced AVB highlights the impact of conduction disturbances on cardiac function.
Background:
Conduction disturbances (CD) are the most frequent complication after transcatheter aortic valve replacement (TAVR), and there continues to be a lack of consensus on their management.
Objective:
To assess new CD and permanent pacemaker (PPM) implantation after TAVR and to evaluate the ventricular pacing percentage (VP) up to 1 year of follow-up.
Methods:
Patients who underwent TAVR from October 2014 to November 2019 were enrolled; patients with previous PPM were excluded. Clinical, procedure, ECG, and PPM data were collected up to 1 year after implantation. The significance level adopted in the statistical analysis was 0.05.
Results:
A total of 340 patients underwent TAVR. The most frequent CD was the new left bundle branch block (LBBB; 32.2%), which 56% resolved after 6 months. Right bundle branch block (RBBB) was the biggest risk factor for advanced atrioventricular block (AVB) [OR=8.46; p<0.001] and PPM implantation [OR=5.18, p<0.001], followed by previous low-grade AVB [OR=2.25; p=0.016 for PPM implantation]. Regarding procedure characteristics, newer generation valves and valve-in-valve procedures were associated with fewer CDs. Overall, 18.5% of patients had a PPM implanted post-TAVR. At first PPM evaluation, patients with advanced AVB had a median percentage of VP of 80% and 83% at one year. Regarding patients with LBBB plus low-grade AVB, median VP was lower (6% at first assessment, p=0.036; 2% at one year, p = 0.065).
Conclusion:
LBBB was the most frequent CD after TAVR, with more than half being resolved in the first six months. RBBB was the major risk factor for advanced AVB and PPM implantation. Advanced AVB was associated with a higher percentage of VP at 1 year of follow-up.
