Why the study?
Conduction abnormalities and permanent pacemaker implantation remain frequent post-TAVI complications with adverse outcomes, especially as TAVI expands to younger low-risk populations, warranting comprehensive strategies such as MSCT-based risk stratification and procedural guidance.
Does multi-sliced CT data interpretation and 3D computational simulation improve the prediction and management of new left bundle branch block and permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation?
Does multi-sliced CT data interpretation and 3D computational simulation improve the prediction and management of new left bundle branch block and permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation?
MSCT-derived anatomical assessment (such as membranous septum length and calcium distribution) and patient-specific 3D computer simulations can refine risk stratification and guide procedural strategies to mitigate conduction abnormalities and permanent pacemaker requirement after TAVI.
Requires vigilance for pacemaker implantation in younger TAVI patients; leaves open targeted prevention strategies for prospective trials.
The demonstrated safety and effectiveness of transcatheter aortic valve implantation (TAVI) among low surgical risk patients opened the road to its application in younger low-risk patients. However, the occurrence of conduction abnormalities and need for permanent pacemaker implantation remains a frequent problem associated with adverse outcomes. The clinical implications may become greater when TAVI shifts towards younger populations, highlighting the need for comprehensive strategies to address this issue. Beyond currently available clinical and electrocardiographic predictors, patient-specific anatomical assessment of the aortic root using multi-sliced CT (MSCT) imaging can refine risk stratification. Moreover, leveraging MSCT data for computational 3D simulations to predict device-anatomy interactions may help guide procedural strategy to mitigate conduction abnormalities. The aims of this review are to summarise the incidence and clinical impact of new left bundle branch block and permanent pacemaker implantation post-TAVI using contemporary transcatheter heart valves; and highlight the value of MSCT data interpretation to improve the management of this complication.
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Nuis et al. (2024) studied this question.
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