Transcatheter aortic valve implantation (TAVI) has rapidly expanded, and indications
have broadened to include patients older than 65 years also eligible for surgical
aortic valve replacement.
1
New-onset left bundle branch block (LBBB) post-TAVI is the most frequent complication
associated with the procedure and has been reported to be associated with a substantial
risk of high-grade atrioventricular (AV) block (5%–35%).
2
The optimal management of new onset LBBB after TAVI remains uncertain. Recent consensus
documents have recommended temporary cardiac pacemaker placement in all patients with
LBBB for 24–48 hours and using either electrophysiology study (EPS) for risk stratification
or prophylactic pacemaker placement in patients with persisting conduction abnormalities.
3
- Lilly S.M.
- Deshmukh A.J.
- Epstein A.E.
- et al.
2020 ACC Expert Consensus decision pathway on management of conduction disturbances
in patients undergoing transcatheter aortic valve replacement: a report of the American
College of Cardiology Solution Set Oversight Committee.
J Am Coll Cardiol. 2020; 76: 2391-2411
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References
- 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021; 143: e72-e227
- Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies.Ann Intern Med. 2013; 158: 35-46
- 2020 ACC Expert Consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American College of Cardiology Solution Set Oversight Committee.J Am Coll Cardiol. 2020; 76: 2391-2411
- Incidence and management of atrio-ventricular conduction disorders in new-onset left bundle branch block after transcatheter aortic valve implantation a prospective multicenter study.Heart Rhythm. 2023; (XX:XX–XX)
- Electrophysiology testing to stratify patients with left bundle branch block after transcatheter aortic valve implantation.J Am Heart Assoc. 2020; 9e014446
- Electrocardiographic and electrophysiological predictors of atrioventricular block after transcatheter aortic valve replacement.Heart Rhythm. 2015; 12: 321-329
- Randomized pragmatic trial of pacemaker versus implantable cardiac monitor in syncope and bifascicular block.JACC Clin Electrophysiol. 2022; 8: 239-248
- A cost-utility analysis of the Syncope: Pacing or Recording in The Later Years (SPRITELY) trial.CJC Open. 2022; 4: 617-624
Article info
Publication history
Published online: January 28, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: The authors have no funding sources to disclose.
Disclosures: The authors have no relationships to disclose.
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