Impact of Conduction Disturbances Post-TAVR

Faroux L, Chen S, Muntané-Carol G, et al.
Clinical Impact of Conduction Disturbances in Transcatheter Aortic Valve Replacement Recipients: A Systematic Review and Meta-Analysis. Eur Heart J 2020;Jan 3:[Epub ahead of print].

The following are key points to remember from this systematic review and meta-analysis on the clinical impact of conduction disturbances in transcatheter aortic valve replacement (TAVR) recipients:

  1. TAVR is the first-line therapy for patients with severe aortic stenosis at intermediate to high surgical risk, with possible expansion to low-risk patients.
  2. Although the incidence of periprocedural complications and death has progressively decreased over time, conduction disturbances such as high-degree atrioventricular block (AVB) leading to permanent pacemaker implantation (PPI) and new-onset persistent left bundle branch block (NOP-LBBB) remain the most frequent complications of TAVR.
  3. The clinical impact of NOP-LBBB and PPI on TAVR recipients remains controversial.
  4. The investigators conducted a systematic search from PubMed and EMBASE databases for studies reporting raw data on the 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR.
  5. Data from 30 studies, including 7,792 patients (12 studies) and 42,927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were analyzed, respectively.
  6. This analysis suggests that NOP-LBBB after TAVR is associated with an increased risk of all-cause death, cardiac death, heart failure hospitalization, and need for PPI at 1-year follow-up, and periprocedural PPI is associated with an increased risk of all-cause death and heart failure hospitalization within the year after TAVR.
  7. Thus, it is critically important to implement preventive measures and improve the management and follow-up of patients with conduction disturbances post-TAVR.
  8. Additional studies are needed to identify those patients at highest risk for conduction disturbances post-TAVR.
  9. This would allow optimized and more uniform targeted treatment strategies in order to improve clinical outcomes.
  10. This will become even a greater issue in the near future with the expansion of TAVR towards the treatment of the majority of patients with aortic stenosis by performing TAVR on patients across the entire surgical risk spectrum (low, intermediate, and high).

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Arrhythmias, Cardiac, Aortic Valve Stenosis, Atrioventricular Block, Bundle-Branch Block, Death, Sudden, Cardiac, Heart Failure, Heart Valve Diseases, Pacemaker, Artificial, Secondary Prevention, Transcatheter Aortic Valve Replacement

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