Post-TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

J Cardiovasc Electrophysiol. 2024 Mar;35(3):488-497. doi: 10.1111/jce.16185. Epub 2024 Jan 22.

Abstract

Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta-analyses identified preexisting right bundle branch block (RBBB), LAHB, and new-onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self-expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post-TAVR, highlighting the need for further research and standardized treatment strategies.

Keywords: aortic stenosis (AS); conduction abnormalities; pacemaker implantation; transcatheter aortic valve replacement.

Publication types

  • Review

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / surgery
  • Bundle-Branch Block / diagnosis
  • Bundle-Branch Block / etiology
  • Bundle-Branch Block / prevention & control
  • Humans
  • Male
  • Pacemaker, Artificial* / adverse effects
  • Risk Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome