Prevalence and clinical outcomes of permanent conduction disturbances after transcatheter aortic valve replacement

Abstract

Background: A new-onset conduction disturbance is a major concern in patients undergoing transcatheter aortic valve replacement (TAVR) but can resolve over time. This study aimed to evaluate the recovery in conduction disturbances post-TAVR and its association with clinical outcomes.

Methods: This retrospective study included 780 TAVR patients at St. Marianna University between January 2016 and March 2023. Patients were stratified into four groups based on conduction status at six months post-TAVR: no conduction disturbance, recovered conduction disturbance [defined as a post-procedural pacemaker implantation with cumulative right ventricular pacing <40 % or complete left bundle branch block (CLBBB) at discharge but not at six months], permanent conduction disturbance (defined as pacemaker implantation with cumulative right ventricular pacing ≥40 % or CLBBB at both discharge and six months), and preprocedural conduction disturbance. The primary outcomes were all-cause mortality and heart failure hospitalization. The secondary outcome was the change in cardiac damage from pre-procedure to one-year post-TAVR.

Results: Of 780 patients, 220 (28 %) had new-onset CLBBB or required a pacemaker implantation at discharge. Among these, 99 (45 %) had permanent conduction disturbances at six months. Over a median follow-up of 788 days, both permanent and preprocedural conduction disturbances were significantly associated with a higher incidence of heart failure hospitalization [hazard ratio (HR) 3.63; 95 % confidence interval (CI): 2.04-6.47, p < 0.01 and HR 2.50; 95 % CI: 1.27-4.90, p < 0.01), although no difference in all-cause mortality was observed. In contrast, the prognosis of patients with recovered conduction disturbance was comparable with those with no conduction disturbance. Patients with permanent and preprocedural conduction disturbances showed significant worsening cardiac damage.

Conclusion: Permanent and preprocedural conduction disturbances after TAVR were associated with increased heart failure hospitalizations, while the prognostic impact of recovered conduction disturbance may be limited.

Keywords: Aortic stenosis; Conduction disturbance; Transcatheter aortic valve replacement.