Conduction Disturbances and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Predictors and Prevention

Authors

Melissa Tsoi, From the Department of Medicine and Cardiology, Tufts Medical Center, Boston, MA.
Kanul Tandon, Department of Medicine and Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Peter J. Zimetbaum, Department of Medicine and Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
William H. Frishman, Department of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY.Follow

Author Type(s)

Faculty

DOI

10.1097/CRD.0000000000000398

Journal Title

Cardiology in Review

First Page

179

Last Page

187

Document Type

Article

Publication Date

7-1-2022

Department

Medicine

Abstract

Conduction disturbances and permanent pacemaker implantation (PPMI) remain a frequent and important consequence of transcatheter aortic valve replacement (TAVR). Understanding risk factors for TAVR-related conduction disturbances could improve patient selection, procedural techniques, and periprocedural efforts for monitoring and treatment of heart block. Several studies have identified patient-related and procedural factors associated with new-onset left bundle branch block, high-degree atrioventricular block, and the need for PPMI after TAVR. Notable patient-related predictors include preexisting right bundle branch block, membranous septal length, and calcification of the left ventricular outflow tract. Modifiable procedural predictors include device implantation depth, prosthesis oversizing, and valve type. This review aims to summarize the current literature examining predictors of conduction disturbances and PPMI after TAVR, particularly with regard to the newer-generation valve types. We also propose a management algorithm for the management of conduction disturbances postprocedure.

Recommended Citation

Tsoi, M., Tandon, K., Zimetbaum, P. J., & Frishman, W. H. (2022). Conduction Disturbances and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Predictors and Prevention. Cardiology in Review, 30 (4), 179-187. https://doi.org/10.1097/CRD.0000000000000398