Conduction dynamics over time after transcatheter aortic valve replacement: An expert review.

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.