Atrioventricular conduction in patients undergoing pacemaker implant following self-expandable transcatheter aortic valve replacement

Pacing Clin Electrophysiol. 2019 Jul;42(7):980-988. doi: 10.1111/pace.13694. Epub 2019 Apr 29.


Background: Heart block requiring a pacemaker is common after self-expandable transcatheter aortic valve replacement (SE-TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown.

Objective: To evaluate the long-term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR.

Methods: All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE-TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow-up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery.

Results: Following SE-TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow-up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long-term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28-0.86]/mm, P = 0.02) predicted lack of conduction recovery.

Conclusions: Half of the patients undergoing CIED placement for heart block following SE-TAVR recovered AV conduction within several months and maintained this over an extended follow-up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.

Keywords: atrioventricular block; conduction recovery; device therapy; pacemaker; transcutaneous aortic valve replacement.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrioventricular Block / physiopathology*
  • Electrocardiography
  • Female
  • Heart Conduction System / physiopathology*
  • Humans
  • Male
  • Pacemaker, Artificial*
  • Transcatheter Aortic Valve Replacement*