Conduction Disturbances After Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives

Circulation. 2017 Sep 12;136(11):1049-1069. doi: 10.1161/CIRCULATIONAHA.117.028352.


Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients' prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.

Keywords: arrhythmias, cardiac; bundle-branch block; pacemaker, artificial; transcatheter aortic valve replacement.

Publication types

  • Review

MeSH terms

  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / surgery*
  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / etiology*
  • Arrhythmias, Cardiac / mortality
  • Bundle-Branch Block / diagnosis*
  • Bundle-Branch Block / etiology*
  • Bundle-Branch Block / mortality
  • Forecasting
  • Humans
  • Mortality / trends
  • Transcatheter Aortic Valve Replacement / adverse effects*
  • Transcatheter Aortic Valve Replacement / mortality
  • Transcatheter Aortic Valve Replacement / trends
  • Treatment Outcome