Evolution of Conduction Disturbances Induced by Transcatheter Aortic Valve Implantation, and Implication in Their Management

Managing conduction disturbances after transcatheter aortic valve implantation (TAVI) remains challenging. Predicting factors of permanent pacemaker (PPM) implantation have been studied but there are scarce data about the type and the long term TAVI induced conduction disturbances. This work aimed to specifically assess each conduction disturbance after TAVI, their incidence and evolution, to improve their management in indication and delay of PPM implantation. This retrospective study included all patients undergoing TAVI at Nancy University Hospital from 2009 to 2016. Patients were followed over 1 year after procedure, with an electrocardiographic control at 3 and 12 months and a device control when implanted with a PPM. A total of 505 TAVI procedures were realized, with a 16.2% PPM implantation rate. Left bundle branch block occurrence (26.9%) seems insufficient to implant a PPM early (at 3 months 53.4% had disappeared, there was no PPM dependency and low ventricular pacing rates; non-implanted patients had good outcomes at 1 year) and should only extend duration of monitoring (34.1% developed a high-degree block, during the first 7 days). Per-procedural high-degree atrioventricular (AV) block should lead to an early PPM implantation when persisting after the procedure day (PPM controls confirmed high ventricular pacing rates), but lead to a conservative approach otherwise (10.3% risk of recurrence during hospitalization, no risk after discharge). Post-procedural transient complete AV block is associated with good outcomes since only 7.1% were PPM-dependent at 3 months and 30.8% had a ventricular pacing rate < 1%; a conservative approach would need further investigations. Specific situations of conduction disturbance lead to different prognosis and should be managed specifically. After 3 months most of patients implanted with PPM have recovered a spontaneous AV conduction, with a low ventricular pacing rate.