Management of conduction disturbances after TAVI: the last step towards early discharge

Abstract

The incidence of new-onset cardiac conduction disturbances following transcatheter aortic valve implantation (TAVI) has not decreased compared to other complications, and nowadays is by far the most frequent drawback following the procedure. Meanwhile, the global management of TAVI recipients has led to a minimalist approach with short postprocedural length of stay, which may be limited by the occurrence of late arrhythmic events in patients at high-risk. This review focuses on those strategies to overcome the conundrum between early discharge and new-onset conduction disturbances in elderly TAVI candidates and provides a perspective on future improvements in this field.

Figure 1

PPI and new-onset LBBB rates using newer generation transcatheter heart valves. LBBB: left bundle branch block; PPI: permanent pacemaker implantation.

Figure 2

Meta-analyses assessing the risk of all-cause death, cardiac death, heart failure hospitalization, and permanent pacemaker implantation in patients with new-onset persistent left bundle branch block following transcatheter aortic valve replacement, and the risk of all-cause death, cardiac death, and heart failure hospitalization in patients with permanent pacemaker implantation following transcatheter aortic valve replacement. Reproduced with permission from Faroux, et al.^[37] CI: confidence interval; RR: risk ratio.

Figure 3

Global management and discharge day proposal according to the occurrence of new-onset CDs. AECG: ambulatory electrocardiogram; CDs: conduction disturbances; CHB: complete heart block; ECG: electrocardiogram; EPS: electrophysiological study; HAVB: high-degree atrioventricular block; LBBB: left bundle branch block; RBBB: right bundle branch block; TAVI: transcatheter aortic valve implantation.