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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Conduction dynamics over time after transcatheter aortic valve replacement: An expert review

Herbert G Kroon1, Thijmen Hokken1, Maarten van Wiechen1

  • 1Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|September 19, 2024
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) frequently causes new conduction disorders like left bundle branch block and atrioventricular block. Understanding these dynamics and predictors is crucial for managing patients with early discharge policies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Conduction disorders are common complications following transcatheter aortic valve replacement (TAVR).
  • Left bundle branch block (LBBB) and third-degree atrioventricular block (AV3B) are significant concerns, impacting patient outcomes.
  • The persistence and pacemaker dependency rates of these disorders require careful consideration, especially with evolving discharge strategies.

Purpose of the Study:

  • To review current knowledge on the dynamics of acquired conduction disorders post-TAVR.
  • To identify predictors associated with the development and persistence of these conduction abnormalities.
  • To provide insights into interpreting these dynamics within the context of early patient discharge.

Main Methods:

  • Systematic review of existing literature on TAVR-related conduction disorders.
  • Analysis of reported incidence, persistence rates, and pacemaker dependency.
  • Extraction and synthesis of identified predictors for conduction disturbances.

Main Results:

  • Left bundle branch block (LBBB) occurs in 20-30% of TAVR patients, persisting in 35-45% at one month.
  • Third-degree atrioventricular block (AV3B) affects approximately 15% of patients.
  • Pacemaker dependency decreases over time, with 25-35% remaining dependent at one year.

Conclusions:

  • Acquired conduction disorders, particularly LBBB and AV3B, are frequent after TAVR and necessitate ongoing monitoring.
  • Understanding predictors can aid in risk stratification and management of these complications.
  • Interpreting conduction disorder dynamics is essential for optimizing early discharge protocols post-TAVR.

Keywords:
Aortic valve stenosisConduction dynamicsTranscatheter aortic valve replacement

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