Key result
TAVR is linked to prolonged sinus, AH, and HV intervals that resolve within 2-4 weeks.
Why the study?
Conduction disturbances requiring permanent pacing frequently complicate TAVR, but the understanding of mechanisms causing conduction block is incomplete.
Does transcatheter aortic valve replacement (TAVR) cause acute and delayed electrophysiologic effects on the atrioventricular conduction system in patients undergoing the procedure?
Cohort (n=409)
No
Does transcatheter aortic valve replacement (TAVR) cause acute and delayed electrophysiologic effects on the atrioventricular conduction system in patients undergoing the procedure?
p-value: p=<0.0001
TAVR causes significant but often transient peri-procedural AV nodal and His bundle conduction disturbances, suggesting standard pacing criteria like marked HV prolongation may not apply acutely.
May not alter acute pacing thresholds despite HV prolongation; leaves open need for prospective validation in larger cohorts.
BACKGROUND: Conduction disturbances requiring permanent pacing frequently complicate transcatheter aortic valve replacement (TAVR). Understanding of mechanisms causing conduction block is incomplete. OBJECTIVE: To characterize the acute and delayed electrophysiologic effects of TAVR on the atrioventricular (AV) conduction system. METHODS: We conducted a single-center prospective cohort study of 409 patients undergoing TAVR. All patients underwent 12-lead electrocardiography and electrophysiologic study (EPS) immediately before and after valve implantation, with continuous ECG and EP monitoring during the TAVR. Seven patients with AV block underwent repeat EPS 1-12 days after TAVR. RESULTS: TAVR was associated with significant prolongation of sinus cycle length, AH and HV intervals, as well as Wenckebach cycle length (all P<0.0001). Transient AV nodal conduction block occurred in 8% of patients with intra-procedural AV block and 12% with post-procedural block. Infra-nodal block occurred in 57 patients, but resolved in 41 by the procedure end. Marked HV interval prolongation (>100ms) without conduction block occurred in 6.4% of patients during TAVR. Intra-His Wenckebach-type block occurred in 9 patients. In 7 patients with follow-up EPS 1-12 days after TAVR improvement or resolution of AV node and infra-nodal conduction abnormalities was seen in all. CONCLUSIONS: Peri-TAVR conduction disturbances may involve both the AV nodal and His bundle. The usual parameters indicating need for permanent pacing (marked HV prolongation) do not apply to TAVR patients. Distinguishing nodal from infranodal involvement can inform prognosis, anticipated recovery, and pacemaker decision-making, particularly given many conduction abnormalities resolved within 2-4 weeks, supporting a refined post-TAVR risk stratification strategy.
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Medline et al. (2026) conducted a cohort in Patients undergoing TAVR (n=409). Transcatheter aortic valve replacement (TAVR) was evaluated on Prolongation of sinus cycle length, AH and HV intervals, and Wenckebach cycle length (p=<0.0001). TAVR was associated with significant prolongation of sinus cycle length, AH and HV intervals, and Wenckebach cycle length (all P<0.0001), with many abnormalities resolving within 2-4 weeks.
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