title: Managing heart block after transcatheter aortic valve implantation: from monitoring to device selection and pacemaker indications.
abstract: The introduction of the so-called newer-generation transcatheter aortic valve implantation (TAVI) devices has led to a dramatic reduction in the incidence of complications associated with the procedure. However, preliminary data suggest that conduction abnormalities (particularly new-onset atrioventricular block and left bundle branch block) remain a frequent complication post TAVI. Although inconsistencies across studies are apparent, new-onset conduction abnormalities post TAVI may be associated with higher incidences of mortality, sudden cardiac death and left ventricular dysfunction. Strategies intended both to reduce the risk and to improve the management of such complications are clearly warranted. In fact, the indication and timing of permanent pacemaker implantation are frequently individualised according to centre and/or operator preference. Currently, studies assessing the impact of these complications and the optimal indications for permanent cardiac pacing are underway. In this article, we review the data available on the incidence and impact of conduction disturbances following TAVI, and propose a strategy for the management of such complications.
authors.affiliation: Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006329:Heart Conduction System / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D010138:Pacemaker, Artificial; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome