Conduction Disorders: The Achilles' Heel of TAVR?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• High-degree conductive disorders (CD) requiring permanent pacemaker implantation (PPI) are significant complications following transcatheter aortic valve replacement (TAVR).
• Current management strategies for post-TAVR CD remain controversial, highlighting a need for clearer guidelines.

Purpose of the Study:

• To review the mechanisms and risk factors associated with CD after TAVR.
• To evaluate the role of electrocardiogram (ECG) and multi-slice computed tomography (MSCT) in assessing anatomical parameters for CD risk.
• To summarize strategies for anticipating, detecting, and managing high-degree CD and optimizing PPI indications post-TAVR.

Main Methods:

• Narrative review of existing literature.
• Literature search using keywords: conductive disorders, TAVR, and pacemaker implantation.
• Focus on ECG evaluation, anatomical parameters from MSCT, and procedural aspects.

Main Results:

• Conductive disorders requiring permanent pacemaker implantation are a primary complication of TAVR.
• A comprehensive evaluation integrating ECG, MSCT-derived anatomical data, and procedural factors is crucial for risk assessment.
• Optimizing PPI indications and exploring novel monitoring and pacing techniques are essential for improved patient care.

Conclusions:

• There is a need for improved strategies to anticipate and detect high-degree CD after TAVR to reduce incidence.
• Clearer recommendations for PPI indications are required to optimize outcomes for patients undergoing TAVR.
• Future perspectives include ambulatory monitoring, machine learning, and advanced pacing techniques for managing post-TAVR CD.