August 1, 2019Journal of the American College of Cardiology
Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement
Why the study?
Conduction disturbances remain the most frequent complication of TAVR, yet an important lack of consensus and high uncertainty regarding their management has led to major differences in post-TAVR pacemaker rates between centers.
Key Points
- The aim is to address the management of conduction disturbances following transcatheter aortic valve replacement (TAVR).
- Developed by a multidisciplinary panel of interventional cardiologists, electrophysiologists, and cardiac surgeons.
- Reviewed existing data and clinical practices related to conduction disturbances and TAVR.
- Formulated consensus recommendations for managing these complications.
- Conduction disturbances remain the most frequent TAVR complication with no decrease over time.
- High variability exists in post-TAVR pacemaker rates across different centers and studies.
- Consensus document aims to provide clarity and a uniform strategy for treating these complications.
Structured PICO
P
Population
Patients with conduction disturbances associated with transcatheter aortic valve replacement (TAVR)
I
Intervention
Management strategies for post-TAVR conduction disturbances
This expert consensus document provides a uniform strategy for managing conduction disturbances, which remain the most frequent complication following TAVR.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's a very humble step forward in order to provide some kind of guidance [in] a field that has been really quite chaotic, I would say, in the last 10 years. Nobody knows exactly what to do, and we have to recognize that the data we had to provide some guidance was really scarce and [more is] badly needed.”
“This paper is a stepping stone in the right direction, and I think as time goes on this is going to be a good platform for future iterations and trying to tailor these algorithms on a more patient-specific level.”
“It's nice that somebody finally tried to make uniform definitions—for example, for what are persistent conduction abnormalities after TAVR and what are delayed conduction abnormalities—because that's been very varied [from] study to study.”
Implication
Standardizes post-TAVR conduction management to curb practice variability; leaves open randomized trials to refine patient-specific algorithms.
Abstract
Despite major improvements in transcatheter aortic valve replacement (TAVR) periprocedural complications in recent years, the occurrence of conduction disturbances has not decreased over time and remains the most frequent complication of the procedure. Additionally, there has been an important lack of consensus on the management of these complications, which has indeed translated into a high degree of uncertainty regarding the most appropriate treatment of a large proportion of such patients along with major differences between centers and studies in pacemaker rates post-TAVR. There is therefore an urgent need for a uniform strategy regarding the management of conduction disturbances after TAVR. The present expert consensus scientific panel document has been formulated by a multidisciplinary group of interventional cardiologists, electrophysiologists, and cardiac surgeons as an initial attempt to provide a guide for the management of conduction disturbances after TAVR based on the best available data and group expertise.
Discussion
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Cite This Study
Rodés‐Cabau et al. (2019) conducted a review in Conduction disturbances associated with transcatheter aortic valve replacement. Management strategies for conduction disturbances was evaluated. An expert consensus scientific panel provides a guide for the management of conduction disturbances after transcatheter aortic valve replacement based on the best available data and group expertise.