Conduction disturbances after transcatheter aortic valve implantation procedures – predictors and management

Abstract

Transcatheter aortic valve implantation (TAVI) has become a safe and efficient alternative to cardiac surgery in patients with severe aortic stenosis. In many countries the number of performed TAVI procedures equals the number of surgical implantations. Indications for TAVI are becoming more liberal, allowing a wider spectrum of patients to benefit from the advantages of transcatheter therapy. Due to its invasive nature, TAVI is associated with some complications such as conduction disturbances. Although these disturbances are usually not lethal, they have a great influence on patients’ state and long term-survival. The most relevant and common are His’ bundle branch blocks, atrioventricular blocks, and need for permanent pacemaker implantation. With the frequency at 10% to even 50%, conduction abnormalities are among the most important TAVI-related adverse events. Risk factors for conduction disturbances include age, anatomy of the heart, periprocedural factors, type of implanted valve, and comorbidities. Severity of occurring complications varies; therefore selection of a proper treatment approach is required. Considered as the most effective management, permanent pacemaker implantation turned out to negatively influence both recovery and survival. Moreover, there is no expert consensus on use of resynchronization therapy after TAVI. In this paper, the authors present a comprehensive analysis of the most common conduction disturbances accompanying TAVI, factors related to their occurrence, and treatment approach.

Sex-related differences in clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

“…Another meta-analysis found greater risk of major vascular complications and major and life-threatening bleeding in women [ 11 ]. Permanent pacemaker implantation and stroke rate were not significantly different between the groups in previously published data [ 9 , 12 , 22 ]. Nevertheless, some studies have also reported that women undergoing TAVI experience higher stroke rate in comparison with men [ 11 , 15 ].…”

Atrioventricular conduction in patients undergoing pacemaker implant following self‐expandable transcatheter aortic valve replacement

“…The cause of this association is not clear but may be related to abnormal aortic and left ventricular outflow tract (LVOT) geometry resulting in increased radial forces being delivered to conductive tissue by the valve prosthesis. This observation is supported by procedural factors associated with new heart block, such as device implantation depth, angle of deployment, and prosthesis to LVOT diameter ratios …”

Pacemaker memory in post‐TAVI patients: Who should benefit from permanent pacemaker implantation?

“…AV conduction damage could be due to hemorrhage, ischemia, or only inflammatory process. In the latter situation, there is a potential for AV conduction recovery . Hence, it is crucial to identify reliable parameters to predict the optimal profile of pacemaker use.…”