Key result
TAVI links to frequent conduction abnormalities, highlighting the need to identify pacemaker risk factors.
Why the study?
The incidence of conduction abnormalities related to TAVI remains high and is associated with worse prognosis, highlighting the need to identify risk factors, assess pacing dependence, and optimize patient care.
What are the mechanisms, risk factors, and management strategies for conduction abnormalities and arrhythmias associated with TAVI?
What are the mechanisms, risk factors, and management strategies for conduction abnormalities and arrhythmias associated with TAVI?
This review highlights the importance of identifying risk factors and optimizing management for TAVI-related conduction abnormalities to improve patient outcomes.
May guide pre-TAVI risk stratification to minimize pacemakers; leaves open prospective validation of management strategies.
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Szotek et al. (2023) conducted a review in Aortic stenosis. Transcatheter aortic valve implantation (TAVI) was evaluated. Transcatheter aortic valve implantation is associated with a high incidence of conduction abnormalities, and identifying risk factors for pacemaker placement is crucial to optimize patient care.
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