Related Experiment Video
Updated: Jun 4, 2025
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Prospective validation of a prespecified algorithm for the management of conduction disturbances after transcatheter
Josep Rodés-Cabau1, Luis Nombela-Franco2, Guillem Muntané-Carol3
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Insights
A new algorithm for managing conduction disturbances after transcatheter aortic valve replacement (TAVR) proved feasible and safe. While it did not increase mortality, permanent pacemaker rates remain high, necessitating further prevention strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Conduction disturbances (CDs) management after transcatheter aortic valve replacement (TAVR) shows significant variability.
- Standardized approaches are needed to optimize patient outcomes post-TAVR.
Purpose of the Study:
- To validate a prespecified algorithm for managing CDs in patients undergoing TAVR.
- To assess the safety and feasibility of a standardized TAVR conduction disturbance management strategy.
Main Methods:
- Prospective, multicenter study of TAVR patients without prior pacemakers.
- Patients stratified by pre-existing right bundle branch block (RBBB) and procedural CDs.
- Primary endpoints: permanent pacemaker (PPM) implantation and 30-day mortality (overall and sudden cardiac death).
Main Results:
- 2110 patients included; 62.9% experienced CDs.
- 15.6% received a PPM within 30 days; rates varied by group (5.5% to 20.7%).
- No significant differences in 30-day all-cause mortality or sudden cardiac death observed across groups.
Conclusions:
- A prespecified algorithm for TAVR-related CDs is feasible and safe.
- The strategy did not increase mortality and showed a very low sudden cardiac death rate.
- High PPM rates persist, highlighting the need for strategies to prevent CDs post-TAVR.
Background:
There is a large variability in the management of conduction disturbances (CDs) after transcatheter aortic valve replacement (TAVR).
Objective:
This study aimed to validate a prespecified algorithm for managing CDs in patients undergoing TAVR.
Methods:
This was a prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR. Patients were stratified in different groups according to the presence of prior right bundle branch block (RBBB) and the occurrence of CDs during the procedure: no prior RBBB and no CDs (group NCD), prior RBBB and no CDs (group RBBB-NCD), and occurrence of CDs (group CD). A management algorithm was prespecified for each group. Permanent pacemaker (PPM) and mortality (overall, sudden cardiac death) at 30 days were the primary end points.
Results:
A total of 2110 TAVR recipients were included. Patients were distributed in NCD (32.0%), RBBB-NCD (5.1%), and CD (62.9%) groups. A total of 329 patients (15.6%) received a PPM at 30 days, with a PPM rate of 5.5%, 15.9%, and 20.7% in the NCD, RBBB-NCD, and CD groups, respectively (P < .001). The PPM rate was 17.4% and 57.2% in patients with procedural new-onset left bundle branch block and high-degree atrioventricular block/complete heart block, respectively. There were no differences in 30-day all-cause mortality and sudden cardiac death between groups (NCD group, 1.2% and 0.2%; RBBB-NCD group, 0% and 0%; CD group, 0.7% and 0.1%; P = .45 and P = .99 for all-cause mortality and sudden cardiac death, respectively).
Conclusion:
A prespecified strategy for the management of CDs in contemporary TAVR recipients was feasible and safe, with no increased mortality and an extremely low rate of sudden cardiac death in patients with CDs. However, PPM rates remained high, and continued efforts for preventing the occurrence of CDs are warranted.
