Advertisement

Conduction disturbances after TAVR with newer-generation self-expanding valves

  • Euihong Ko
    Affiliations
    Department of Cardiology, Kokura Memorial Hospital, Kitakyushu-city, Fukuoka, Japan
    Search for articles by this author
  • Duk-Woo Park
    Correspondence
    Corresponding author at: Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
    Affiliations
    Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
      The iteration of transcatheter aortic valve replacement (TAVR) devices along with cumulative technical experiences have substantially contributed to a reduction of periprocedural complications and mortality. Nevertheless, high-degree conduction disturbances (HDCD) requiring permanent pacemaker implantation (PPI) and new-onset left bundle branch block (LBBB) still remain one of most frequent complications after TAVR, especially for self-expandable valves (SEV) [
      • Auffret V.
      • Lefevre T.
      • Van Belle E.
      • Eltchaninoff H.
      • Iung B.
      • Koning R.
      • et al.
      Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI.
      ,
      • Auffret V.
      • Puri R.
      • Urena M.
      • Chamandi C.
      • Rodriguez-Gabella T.
      • Philippon F.
      • et al.
      Conduction disturbances after transcatheter aortic valve replacement.
      ]. The rate of PPI after TAVR seems to be different across various types of TAVR prosthesis. Compared with early-generation balloon-expandable valve (BEV), the rate of PPI did not significantly improve with newer-generation balloon-expandable valve (BEV). On the other hand, the rate of PPI has been reduced with the newer-generation of self-expandable CoreValve system [
      • van Rosendael P.J.
      • Delgado V.
      • Bax J.J.
      Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review.
      ]. The pathological relationship between conduction disturbance and implantation depth was based on an anatomic foundation. The His-bundle bifurcates at the inferior border of the membranous septum (MS), with the left bundle emerging beneath the non-coronary cusp. Thus, a smaller difference between the MS length and implantation depth was a strong predictor of new-onset high-degree AVB and PPI after TAVR.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Auffret V.
        • Lefevre T.
        • Van Belle E.
        • Eltchaninoff H.
        • Iung B.
        • Koning R.
        • et al.
        Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI.
        J. Am. Coll. Cardiol. 2017; 70: 42-55
        • Auffret V.
        • Puri R.
        • Urena M.
        • Chamandi C.
        • Rodriguez-Gabella T.
        • Philippon F.
        • et al.
        Conduction disturbances after transcatheter aortic valve replacement.
        Circulation. 2017; 136: 1049-1069
        • van Rosendael P.J.
        • Delgado V.
        • Bax J.J.
        Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review.
        Eur. Heart J. 2018; 39: 2003-2013
        • Mazzella A.J.
        • Hendrickson M.J.
        • Arora S.
        • Sanders M.
        • Li Q.
        • Vavalle J.P.
        • et al.
        Shifting trends in timing of pacemaker implantation after transcatheter aortic valve replacement.
        J. Am. Coll. Cardiol. Intv. 2021; 14: 232-234
        • Rodés-Cabau J.
        • Ellenbogen K.A.
        • Krahn A.D.
        • Latib A.
        • Mack M.
        • Mittal S.
        • et al.
        Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel.
        J. Am. Coll. Cardiol. 2019; 74: 1086-1106
        • Castro-Mejía A.F.
        • Amat-Santos I.
        • Ortega-Armas M.E.
        • Baz J.A.
        • Moreno R.
        • Diaz J.F.
        • et al.
        Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: a real world multicenter analysis.
        Int. J. Cardiol. 2022; 362: 128-136
        • Jilaihawi H.
        • Zhao Z.
        • Du R.
        • Staniloae C.
        • Saric M.
        • Neuburger P.J.
        • et al.
        Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement.
        J. Am. Coll. Cardiol. Intv. 2019; 12: 1796-1807
        • Miyamoto J.
        • Ohno Y.
        • Sakai K.
        • Murakami T.
        • Horinouchi H.
        • Hasegawa M.
        • et al.
        Novel strategy for patients with pre-existing right bundle branch block: membranous septum guided TAVR.
        J. Am. Coll. Cardiol. Intv. 2020; 13: 2184-2185