Recovery of atrioventricular conduction in patients with heart block after transcatheter aortic valve replacement

Abstract

A majority of patients who receive PPMs for HD-AVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that programming to minimize ventricular pacing may be beneficial in a majority of these patients.

Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

“…The reported incidences of HDAVB after TAVI varied depending on the type of valve used in the procedure; 6.8% to 10.8% for BEV and 19.3% to 35.7% for SEV . Despite lack of specific information for the type of valve, our analysis mostly reflects data on BEV, since the national registry data in the United States up to September 2014 showed an 11.2% rate of SEV use .…”

“…Although such injuries can be irreversible, both SAVR and TAVI often cause periprocedural edema of the surrounding tissue, resulting in transient HDAVB that recovers within a few days to several weeks . In a recent study, pacemaker interrogations at outpatient follow‐up after TAVI revealed resolution of HDAVB in 61% of patients, with the vast majority of recovery occurring within one month . Similarly, other studies reported that only one‐third to a half of the patients who underwent pacemaker implantation for complete AV block exhibited persistent complete AV block …”

“…in the TAVI group and 5.6% in the SAVR group; (2) permanent pacemakers were implanted earlier after TAVI compared to SAVR (the median interval of 2 days vs 5 days); and (3) among the patients who developed HDAVB, patients in the TAVI group were more likely to undergo permanent pacemaker implantation than those in the SAVR group (74.1% vs 64.7%). [15][16][17]20 Despite lack of specific information for the type of valve, our analysis mostly reflects data on BEV, since the national registry data in the United States up to September 2014 showed an 11.2% rate of SEV use. 14 Considering these factors, the 10.3% incidence of HDAVB after TAVI in our cohort is overall consistent with prior reports.…”

Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement

“…In a study by Guetta et al, 96% of patients who developed high‐degree AVB required a PPM within 5 days of TAVR . It should be noted, however, that the block is often transient and does not always require a long‐term pacemaker . Studies have shown complete recovery of the block within 1 month following implantation in up to 65% of patients .…”

“…It should be noted, however, that the block is often transient and does not always require a long‐term pacemaker . Studies have shown complete recovery of the block within 1 month following implantation in up to 65% of patients . Therefore, caution should be taken when considering PPM implantation for patients with a complete AVB because of the possibility that recovery will reduce the need for long‐term pacing.…”