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Published on: February 26, 2013
A Systematic Review of Delayed High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation
Karan Rao1,2,3, Bernard Chan1,3, Alexandra Baer2
1Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
Insights
Delayed high-grade atrioventricular block (HGAVB) after transcatheter aortic valve implantation (TAVI) occurs in 1.7%–14.6% of patients. Further research is needed to understand risk factors and implications of this serious complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- High-grade atrioventricular block (HGAVB) is a frequent complication following transcatheter aortic valve implantation (TAVI), often requiring permanent pacemaker (PPM) implantation.
- Delayed HGAVB, typically defined as occurring 48 hours post-TAVI or after discharge, presents a significant risk, potentially leading to syncope and sudden cardiac death.
Purpose of the Study:
- To estimate the incidence of delayed HGAVB after TAVI.
- To identify limitations in the current literature regarding delayed HGAVB.
Main Methods:
- A systematic review was conducted using Medline, Cochrane, Web of Science, and Scopus databases.
- Studies focusing on "delayed" or "late" atrioventricular block post-TAVI were included, excluding patients with prior PPM or aortic valve surgery.
- The initial search identified 775 studies, with 19 ultimately included after screening.
Main Results:
- The review included 19 studies encompassing 14,898 patients, with a mean age of 81.7 years and 46.3% males.
- The incidence of delayed HGAVB varied widely, ranging from 1.7% to 14.6% across the studies.
- Significant methodologic heterogeneity was observed among the included studies, impacting the reliability of the reported incidence rates.
Conclusions:
- Delayed HGAVB is a recognized and potentially severe complication of TAVI, sharing risk factors with acute HGAVB.
- The increasing trend towards early discharge post-TAVI necessitates further prospective research.
- Future studies should aim to enhance the understanding of predisposing factors, precise incidence, timing, and clinical implications of delayed HGAVB.
Background:
High-grade atrioventricular block (HGAVB) is common after transcatheter aortic valve implantation (TAVI), often necessitating permanent pacemaker (PPM) implantation. Delayed HGAVB has varying definitions but typically refers to onset 48 hours after TAVI or following discharge and may cause syncope and sudden cardiac death. This review estimates the incidence of delayed HGAVB and identifies limitations of current literature.
Methods:
A systematic review was performed of the following online databases: Medline, Cochrane, Web of Science, and Scopus. Studies that labelled the outcome of "delayed" or "late" atrioventricular block after TAVI were included; patients with previous PPM or aortic valve surgery were excluded. Initial search yielded 775 studies, which, after screening, was narrowed to 19 studies.
Results:
Nineteen studies with 14,898 patients were included. Mean age was 81.7 years, and 46.3% were male. Mean Society of Thoracic Surgeons (STS) score was 5.6%, and 31.3% of patients had known atrial fibrillation. The most common access site was transfemoral (84.8%), whereas balloon-expandable valves were used in 62.1%, self-expanding valves in 34.0%, and mechanically expanding valves in 3.9% of cases. The incidence of delayed HGAVB ranged from 1.7% to 14.6%, with significant methodologic heterogeneity noted among the included studies.
Conclusions:
Delayed HGAVB is a common and potentially serious complication of TAVI, with similar risk factors to acute HGAVB. With a move toward an early discharge strategy post-TAVI, further prospective study of delayed HGAVB is warranted to improve understanding of predisposing factors, incidence, timing, and implications.
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