Late-onset atrioventricular block after transcatheter aortic valve replacement

Kyong Hee Lee; Atsuhiko Yagishita; Yohei Ohno; Tetsuri Sakai; Katsuaki Sakai; Junichi Miyamoto; Hitomi Horinouchi; Susumu Sakama; Norihiko Kamioka; Tsutomu Murakami; Kengo Ayabe; Mari Amino; Koichiro Yoshioka; Yuji Ikari

doi:10.1016/j.hroo.2021.11.001

Late-onset atrioventricular block after transcatheter aortic valve replacement

Heart Rhythm O2. 2021 Nov 5;2(6Part A):607-613. doi: 10.1016/j.hroo.2021.11.001. eCollection 2021 Dec.

Affiliation

¹ Department of Cardiology, Tokai University, Kanagawa, Japan.

Abstract

Background: Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain.

Objectives: We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR.

Methods: This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR.

Results: Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97-9.05, log-rank P = .09).

Conclusion: Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.

Keywords: Complete atrioventricular block; Late-onset atrioventricular block; Late-onset pacemaker implantation; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement.