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Published on: June 3, 2018
Conductive disturbances in the transcatheter aortic valve implantation setting: An appraisal of current knowledge and
Léo Lemarchand1, Dominique Boulmier1, Guillaume Leurent1
1Service de cardiologie, CHU de Rennes, université de Rennes 1, Inserm LTSI U1099, 35000 Rennes, France.
Insights
New conduction problems after transcatheter aortic valve implantation (TAVI) are common. A multimodal approach for risk assessment and defined follow-up strategies are needed to improve patient outcomes following TAVI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- New-onset conduction disturbances, such as left bundle branch block, are a significant complication post-transcatheter aortic valve implantation (TAVI).
- Current preprocedural risk assessment relies heavily on baseline electrocardiogram, potentially missing crucial information.
Purpose of the Study:
- To review current knowledge on managing conduction disturbances after TAVI.
- To explore future perspectives from preprocedural assessment to long-term follow-up.
Main Methods:
- Review of existing literature and guidelines on TAVI-related conduction disturbances.
- Discussion of multimodal preprocedural risk assessment strategies.
- Analysis of current and proposed follow-up management protocols.
Main Results:
- Baseline electrocardiogram is insufficient for comprehensive risk stratification.
- Ambulatory electrocardiogram monitoring and multidetector computed tomography offer valuable insights.
- Management during the hospital phase and long-term follow-up require further definition.
Conclusions:
- A multimodal approach is essential for accurate preprocedural risk assessment of conduction disturbances post-TAVI.
- Standardized management and follow-up protocols are necessary to address this clinical challenge.
Abstract:
New-onset conduction disturbances, including left bundle branch block and permanent pacemaker implantation, remain a major issue after transcatheter aortic valve implantation. Preprocedural risk assessment in current practice is most often limited to evaluation of the baseline electrocardiogram, whereas it may benefit from a multimodal approach, including ambulatory electrocardiogram monitoring and multidetector computed tomography. Physicians may encounter equivocal situations during the hospital phase, and the management of follow-up is not fully defined, despite the publication of several expert consensuses and the inclusion of recommendations regarding the role of electrophysiology studies and postprocedural monitoring in recent guidelines. This review provides an overview of current knowledge and future perspectives regarding the management of new-onset conduction disturbances in the setting of transcatheter aortic valve implantation, from the preprocedural phase to long-term follow-up.
