Prognostic impact of conduction disturbance subtypes after transcatheter aortic valve implantation

BACKGROUND: Conduction disturbances (CD) are common in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Although various types of CD occur, the prognostic differences among CD subtypes, including transient and persistent CD, have not been systematically evaluated. METHODS: This retrospective two-center study included 1007 patients with AS who underwent TAVI between August 2016 and September 2024. According to Valve Academic Research Consortium-3 (VARC-3) criteria, CD were defined as left or right bundle branch block, intraventricular conduction delay with QRS ≥ 120 ms, high-degree atrioventricular block (including complete atrioventricular block), or new permanent pacemaker implantation. Patients were categorized into 4 groups: pre-existing CD, transient CD (resolved by discharge or within 7 days), persistent CD (present at discharge or beyond 7 days), or no CD. The primary endpoint was a composite of cardiovascular death or heart failure hospitalization up to 2 years. RESULTS: Of the 1007 patients, 234 (23.2%) had pre-existing CD, 112 (11.1%) had persistent CD, 159 (15.8%) had transient CD, and 502 (49.9%) had no CD. During a median follow-up of 645 days, 109 patients (10.8%) experienced the primary endpoint. The persistent CD group had a higher incidence of the primary endpoint than the other groups (log-rank P = 0.023). CONCLUSIONS: Persistent CD, but not transient or pre-existing CD, independently predicted adverse outcomes after TAVI. This study highlights the prognostic importance of CD persistence for post-TAVI risk stratification.