Impact of Early Atrioventricular Nodal Blocker Use Post-Transcatheter Aortic Valve Replacement

High-degree atrioventricular block (AVB) and permanent pacemaker (PPM) implantation remain common complications following transcatheter aortic valve replacement (TAVR). Limited evidence exists on whether early postprocedural administration of atrioventricular (AV) nodal blocking medications impacts these outcomes.

This study aimed to evaluate the safety of AV nodal blocker use within the first 48 h after TAVR.

A retrospective cohort study was conducted in adults who underwent TAVR from January 1, 2016 to April 2, 2024. The population was divided into two cohorts based on administration of an AV nodal blocker within the first 48 h. The primary endpoint was the rate of second-degree or higher AVB at 30 days.

A total of 756 patients met the study criteria, with 381 (50.4%) receiving an AV nodal blocker within 48 h. The primary outcome occurred in 2.7% of patients who did not receive an AV nodal blocker and 1.6% of those who did (p = 0.297). No significant difference was observed in second-degree or higher AVB at discharge, PPM placement at 30 days, or hospital length of stay. All-cause mortality at 30 days was significantly higher in the AV nodal blocker group (2.4% vs. 0.3%, p = 0.011), but this difference did not remain significant after adjusting for covariates.

AV nodal blocker use within 48 h following TAVR was not associated with an increased rate of second-degree or higher AVB or PPM placement. These findings suggest that AV nodal blockers may be considered in the immediate post-TAVR period based on risk-benefit assessment.