Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

Anthony J Mazzella; Sameer Arora; Michael J Hendrickson; Mason Sanders; John P Vavalle; Anil K Gehi

doi:10.15420/cfr.2021.05

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

Card Fail Rev. 2021 Jul 27:7:e12. doi: 10.15420/cfr.2021.05. eCollection 2021 Mar.

Authors

Anthony J Mazzella¹, Sameer Arora¹, Michael J Hendrickson², Mason Sanders³, John P Vavalle¹, Anil K Gehi¹

Affiliations

¹ Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US.
² University of North Carolina School of Medicine Chapel Hill, NC, US.
³ Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US.

Abstract

Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.

Keywords: Transcatheter aortic valve replacement; ambulatory monitoring; atrial fibrillation; heart block; pacemaker; temporary pacing.

Publication types

Review