Late-onset atrioventricular block after transcatheter aortic valve replacement

Abstract

Background Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain. Objectives We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR. Methods This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR. Results Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97–9.05, log-rank P = .09). Conclusion Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.

A prediction model for permanent pacemaker implantation after transcatheter aortic valve replacement

“…Evidence from previous studies showed that PPMI can occur beyond 30 days after TAVR [ 33 ]. The medical records of patients with PPMI beyond 30 days after TAVR in the derivation set showed that most of these patients experienced amaurosis or syncope within 30 days after TAVR, but did not seek appropriate medical treatment in time.…”

Numbing the Heart to Death: A Cautionary Tale About an In-Vogue Preoperative Analgesic

“…Those with transient atrioventricular block are at risk for recurrence of atrioventricular block, usually within days, although atrioventricular block even later than 30 days can occur. 1 Therefore, late atrioventricular block was not anticipated in this patient before symptoms. Approximately 15% of patients receive a permanent pacemaker after TAVR.…”

Prognostic impact of new permanent pacemaker implantation following transcatheter aortic valve replacement

“…Several studies showed that chronic right ventricular pacing has been associated with adverse effects on ventricular function and an increased risk of morbidity and mortality in long‐term follow‐up of non‐TAVR patients 4–6 . However, long‐term data on the prognostic impact of post‐TAVR PPI remain controversial 7–9 . We now report the impact of new PPI on clinical outcomes in patients undergoing TAVR at our center.…”

“…[4][5][6] However, long-term data on the prognostic impact of post-TAVR PPI remain controversial. [7][8][9] We now report the impact of new PPI on clinical outcomes in patients undergoing TAVR at our center.…”