A Systematic Review of Delayed High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation

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.