Cardiac conduction system disease after transcatheter aortic valve replacement
ABSTRACT Transcatheter aortic valve replacement (TAVR) is a rapidly-evolving technology for patients with severe, calcific aortic stenosis. Although these procedures lessen many of the risks and complications of open surgical aortic valve replacement, there remain challenges with TAVR including electrophysiologic complications. Among TAVR prostheses, rates of conduction abnormalities (CAs) vary from less than 10% to more than 50%, with up to one-third of patients requiring placement of a permanent pacemaker following TAVR. Several predictors of CAs have been identified related to device selection, baseline conduction defects, and anatomical considerations. Current data support the hypothesis that CAs result primarily from mechanical compression of the specialized conduction system by the device, although other factors may be involved. Such abnormalities can arise immediately during the procedure or as late as several days after implantation, and can be transient or permanent. Currently, there are no clinical tools to identify patients at highest risk for CAs post-TAVR, or to predict the course of CAs in patients who experience them. Early data suggest outcomes may be worse in high-risk patients, and further studies are needed to identify these patients so as to minimize electrophysiologic complications and determine appropriate monitoring in this expanding population.
- Archives des Maladies du Coeur et des Vaisseaux - Pratique 04/2013; 2013(217):13–19. DOI:10.1016/S1261-694X(13)70493-0
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ABSTRACT: OPINION STATEMENT: Transcatheter aortic valve implantation (TAVI) is a less invasive approach to aortic valve replacement than traditional open chest surgery. It has been very successful in elderly and sick patients who might have otherwise been turned down for surgery. However, many patients who have the procedure develop conduction disease, including new LBBB or complete heart block, and may need permanent pacing or ongoing follow-up to monitor for worsening conduction problems. Here we discuss the risk for conduction disease with TAVI, identifying which patients may need a pacemaker or long-term rhythm follow-up, and methods to decrease the risk of worsening conduction.Current Treatment Options in Cardiovascular Medicine 05/2013; 15(4). DOI:10.1007/s11936-013-0245-6
- EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2013; 9 Suppl(S):S97-S100. DOI:10.4244/EIJV9SSA19