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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Related Experiment Video

Updated: Jan 11, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Minimizing Permanent Pacemaker Implantation After TAVR: Current Strategies, Monitoring Pathways, and Future

Alfonso Reyes Mitre1, Hector Lopez de la Garza2, Claudio Espada Guerreiro3

  • 1Hemodynamic & Interventional Cardiology Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Estrada Clara Campoamor 341, 36312 Vigo, Spain.

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Summary

Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis. While effective, conduction disturbances requiring permanent pacemaker implantation (PPI) are common complications.

Keywords:
balloon-expandable valvecusp-overlap techniqueelectrophysiological studyleft anterior fascicular blockmembranous septumpermanent pacemaker implantationright bundle branch blocktranscatheter aortic valve implantation

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Transcatheter aortic valve replacement (TAVR) is a primary therapy for severe symptomatic aortic stenosis, now used across all surgical risk categories.
  • Despite advancements, conduction disturbances leading to permanent pacemaker implantation (PPI) are frequent TAVR complications, occurring in 8-20% of cases.
  • Predictors of post-TAVR conduction disturbances include clinical, anatomical, and procedural factors.

Purpose of the Study:

  • To review the current understanding of conduction disturbances following TAVR.
  • To outline a comprehensive, evidence-based approach to mitigate PPI after TAVR.
  • To highlight the potential of a multimodal framework to improve TAVR outcomes and expand its use.

Main Methods:

  • Review of clinical evidence and procedural data related to TAVR.
  • Identification and analysis of risk factors for post-TAVR conduction disturbances.
  • Synthesis of strategies for risk assessment, procedural planning, device selection, and monitoring.

Main Results:

  • Conduction disturbances and PPI are significant complications of TAVR, with incidence varying by prosthesis and patient factors.
  • Several clinical, anatomical, and procedural factors predict the likelihood of developing conduction disturbances post-TAVR.
  • A multimodal approach integrating risk assessment, planning, device choice, and monitoring can reduce PPI rates.

Conclusions:

  • A comprehensive, evidence-based strategy is crucial for minimizing conduction disturbances and PPI after TAVR.
  • Optimizing TAVR procedures through careful planning and patient selection can enhance safety and resource utilization.
  • Reducing PPI incidence supports the expanding use of TAVR in younger, lower-risk patients.