Research status of cardiac conduction block after transcatheter aortic valve replacement_West China Medical Journal

Authors：

DAI Hanyi , ZHU Qifeng ,  LIU Xianbao

Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P. R. China;

Corresponding author：

LIU Xianbao, Email: liuxb@zju.edu.cn

Keywords：

Transcatheter aortic valve replacement; Aortic valve stenosis; Cardiac conduction block

DOI：

10.7507/1002-0179.202107266

Video：

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Cardiac conduction block is one of the most common perioperative complications of transcatheter aortic valve replacement (TAVR), a proportion of which will resolve spontaneously over time, but its incidence has not decreased with the iteration of instruments. It is associated with poor prognosis of patients. The prevention and management strategies of cardiac conduction block after TAVR are still being explored. This paper expounds the mechanism, influence, incidence, predictors, management of cardiac conduction block and indications, timing of permanent pacemaker implantation to provide a reference for the prevention and management of cardiac conduction block after TAVR in clinical practice.

Citation： DAI Hanyi, ZHU Qifeng, LIU Xianbao. Research status of cardiac conduction block after transcatheter aortic valve replacement. West China Medical Journal, 2021, 36(9): 1167-1171. doi: 10.7507/1002-0179.202107266 Copy

1.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
2.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
3.	Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
4.	Sammour Y, Krishnaswamy A, Kumar A, et al. Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2021, 14(2): 115-134.
5.	Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
6.	Ando T, Takagi H, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. The prognostic impact of new-onset persistent left bundle branch block following transcatheter aortic valve implantation: a meta-analysis. Clin Cardiol, 2016, 39(9): 544-550.
7.	Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
8.	Nazif TM, Chen S, George I, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER Ⅱ trial. Eur Heart J, 2019, 40(27): 2218-2227.
9.	Toggweiler S, Stortecky S, Holy E, et al. The electrocardiogram after transcatheter aortic valve replacement determines the risk for post-procedural high-degree AV block and the need for telemetry monitoring. JACC Cardiovasc Interv, 2016, 9(12): 1269-1276.
10.	Urena M, Webb JG, Eltchaninoff H, et al. Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death. J Am Coll Cardiol, 2015, 65(5): 437-448.
11.	Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.
12.	Jørgensen TH, De Backer O, Gerds TA, et al. Mortality and heart failure hospitalization in patients with conduction abnormalities after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(1): 52-61.
13.	Baldasseroni S, Opasich C, Gorini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J, 2002, 143(3): 398-405.
14.	Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
15.	Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv, 2015, 8(1PtA): 60-69.
16.	Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U. S. Society of Thoracic Surgeons / American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
17.	VARC-3 Writing Committee, Généreux P, Piazza N, et al. Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol, 2021, 77(21): 2717-2746.
18.	Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
19.	Roten L, Meier B. Left bundle branch block after transcatheter aortic valve implantation: still a matter of concern?. JACC Cardiovasc Interv, 2014, 7(2): 137-139.
20.	Testa L, Latib A, De Marco F, et al. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve Revalving System. Circulation, 2013, 127(12): 1300-1307.
21.	Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
22.	Lilly SM, Deshmukh AJ, Epstein AE, et al. 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 76(20): 2391-2411.
23.	Ream K, Sandhu A, Valle J, et al. Ambulatory rhythm monitoring to detect late high-grade atrioventricular block following transcatheter aortic valve replacement. J Am Coll Cardiol, 2019, 73(20): 2538-2547.
24.	Maeno Y, Abramowitz Y, Kawamori H, et al. A highly predictive risk model for pacemaker implantation after TAVR. JACC Cardiovasc Imaging, 2017, 10(10PtA): 1139-1147.
25.	Mauri V, Reimann A, Stern D, et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement with the SAPIEN 3. JACC Cardiovasc Interv, 2016, 9(21): 2200-2209.
26.	van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J, 2018, 39(21): 2003-2013.
27.	Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.
28.	Husser O, Pellegrini C, Kim WK, et al. Transcatheter valve SELECTion in patients with right bundle branch block and impact on pacemaker implantations. JACC Cardiovasc Interv, 2019, 12(18): 1781-1793.
29.	van Gils L, Tchetche D, Lhermusier T, et al. Transcatheter heart valve selection and permanent pacemaker implantation in patients with pre-existent right bundle branch block. J Am Heart Assoc, 2017, 6(3): e005028.
30.	Fischer Q, Himbert D, Webb JG, et al. Impact of preexisting left bundle branch block in transcatheter aortic valve replacement recipients. Circ Cardiovasc Interv, 2018, 11(11): e006927.
31.	Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
32.	Hamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(9): 1218-1228.
33.	De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from Edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve imp lantation: the critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
34.	Writing Committee Members, Kusumoto FM, Schoenfeld MH, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm, 2019, 16(9): e128-e226.
35.	Jørgensen TH, De Backer O, Gerds TA, et al. Immediate post-procedural 12-lead electrocardiography as predictor of late conduction defects after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(15): 1509-1518.
36.	Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
37.	Rodés-Cabau J, Urena M, Nombela-Franco L, et al. Arrhythmic burden as determined by ambulatory continuous cardiac monitoring in patients with new-onset persistent left bundle branch block following transcatheter aortic valve replacement: the MARE study. JACC Cardiovasc Interv, 2018, 11(15): 1495-1505.
38.	Urena M, Hayek S, Cheema AN, et al. Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement. Circulation, 2015, 131(5): 469-477.
39.	Miyamoto J, Ohno Y, Sakai K, et al. Novel strategy for patients with pre-existing right bundle branch block: membranous septum guided TAVR. JACC Cardiovasc Interv, 2020, 13(18): 2184-2185.
40.	Krishnaswamy A, Sammour Y, Mangieri A, et al. The utility of rapid atrial pacing immediately post-TAVR to predict the need for pacemaker implantation. JACC Cardiovasc Interv, 2020, 13(9): 1046-1054.
41.	Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J, 2013, 34(29): 2281-2329.
42.	Wayangankar SA, Elgendy IY, Xiang Q, et al. Length of stay after transfemoral transcatheter aortic valve replacement: an analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. JACC Cardiovasc Interv, 2019, 12(5): 422-430.
43.	Kapadia SR, Wazni O, Krishnaswamy A. Pacemaker implantation after TAVR. JACC Cardiovasc Imaging, 2017, 10(10PtA): 1148-1150.
44.	Sharma PS, Subzposh FA, Ellenbogen KA, et al. Permanent His-bundle pacing in patients with prosthetic cardiac valves. Heart Rhythm, 2017, 14(1): 59-64.
45.	Lv F, Pan XH, Fan JQ, et al. A case of a successful post-transcatheter aortic valve replacement His bundle pacing. World J Emerg Med, 2021, 12(2): 157-159.

1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
2. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
3. Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
4. Sammour Y, Krishnaswamy A, Kumar A, et al. Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2021, 14(2): 115-134.
5. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
6. Ando T, Takagi H, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. The prognostic impact of new-onset persistent left bundle branch block following transcatheter aortic valve implantation: a meta-analysis. Clin Cardiol, 2016, 39(9): 544-550.
7. Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
8. Nazif TM, Chen S, George I, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER Ⅱ trial. Eur Heart J, 2019, 40(27): 2218-2227.
9. Toggweiler S, Stortecky S, Holy E, et al. The electrocardiogram after transcatheter aortic valve replacement determines the risk for post-procedural high-degree AV block and the need for telemetry monitoring. JACC Cardiovasc Interv, 2016, 9(12): 1269-1276.
10. Urena M, Webb JG, Eltchaninoff H, et al. Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death. J Am Coll Cardiol, 2015, 65(5): 437-448.
11. Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.
12. Jørgensen TH, De Backer O, Gerds TA, et al. Mortality and heart failure hospitalization in patients with conduction abnormalities after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(1): 52-61.
13. Baldasseroni S, Opasich C, Gorini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J, 2002, 143(3): 398-405.
14. Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
15. Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv, 2015, 8(1PtA): 60-69.
16. Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U. S. Society of Thoracic Surgeons / American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
17. VARC-3 Writing Committee, Généreux P, Piazza N, et al. Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol, 2021, 77(21): 2717-2746.
18. Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
19. Roten L, Meier B. Left bundle branch block after transcatheter aortic valve implantation: still a matter of concern?. JACC Cardiovasc Interv, 2014, 7(2): 137-139.
20. Testa L, Latib A, De Marco F, et al. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve Revalving System. Circulation, 2013, 127(12): 1300-1307.
21. Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
22. Lilly SM, Deshmukh AJ, Epstein AE, et al. 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 2020, 76(20): 2391-2411.
23. Ream K, Sandhu A, Valle J, et al. Ambulatory rhythm monitoring to detect late high-grade atrioventricular block following transcatheter aortic valve replacement. J Am Coll Cardiol, 2019, 73(20): 2538-2547.
24. Maeno Y, Abramowitz Y, Kawamori H, et al. A highly predictive risk model for pacemaker implantation after TAVR. JACC Cardiovasc Imaging, 2017, 10(10PtA): 1139-1147.
25. Mauri V, Reimann A, Stern D, et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement with the SAPIEN 3. JACC Cardiovasc Interv, 2016, 9(21): 2200-2209.
26. van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J, 2018, 39(21): 2003-2013.
27. Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.
28. Husser O, Pellegrini C, Kim WK, et al. Transcatheter valve SELECTion in patients with right bundle branch block and impact on pacemaker implantations. JACC Cardiovasc Interv, 2019, 12(18): 1781-1793.
29. van Gils L, Tchetche D, Lhermusier T, et al. Transcatheter heart valve selection and permanent pacemaker implantation in patients with pre-existent right bundle branch block. J Am Heart Assoc, 2017, 6(3): e005028.
30. Fischer Q, Himbert D, Webb JG, et al. Impact of preexisting left bundle branch block in transcatheter aortic valve replacement recipients. Circ Cardiovasc Interv, 2018, 11(11): e006927.
31. Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
32. Hamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(9): 1218-1228.
33. De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from Edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve imp lantation: the critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
34. Writing Committee Members, Kusumoto FM, Schoenfeld MH, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm, 2019, 16(9): e128-e226.
35. Jørgensen TH, De Backer O, Gerds TA, et al. Immediate post-procedural 12-lead electrocardiography as predictor of late conduction defects after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(15): 1509-1518.
36. Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
37. Rodés-Cabau J, Urena M, Nombela-Franco L, et al. Arrhythmic burden as determined by ambulatory continuous cardiac monitoring in patients with new-onset persistent left bundle branch block following transcatheter aortic valve replacement: the MARE study. JACC Cardiovasc Interv, 2018, 11(15): 1495-1505.
38. Urena M, Hayek S, Cheema AN, et al. Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement. Circulation, 2015, 131(5): 469-477.
39. Miyamoto J, Ohno Y, Sakai K, et al. Novel strategy for patients with pre-existing right bundle branch block: membranous septum guided TAVR. JACC Cardiovasc Interv, 2020, 13(18): 2184-2185.
40. Krishnaswamy A, Sammour Y, Mangieri A, et al. The utility of rapid atrial pacing immediately post-TAVR to predict the need for pacemaker implantation. JACC Cardiovasc Interv, 2020, 13(9): 1046-1054.
41. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J, 2013, 34(29): 2281-2329.
42. Wayangankar SA, Elgendy IY, Xiang Q, et al. Length of stay after transfemoral transcatheter aortic valve replacement: an analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. JACC Cardiovasc Interv, 2019, 12(5): 422-430.
43. Kapadia SR, Wazni O, Krishnaswamy A. Pacemaker implantation after TAVR. JACC Cardiovasc Imaging, 2017, 10(10PtA): 1148-1150.
44. Sharma PS, Subzposh FA, Ellenbogen KA, et al. Permanent His-bundle pacing in patients with prosthetic cardiac valves. Heart Rhythm, 2017, 14(1): 59-64.
45. Lv F, Pan XH, Fan JQ, et al. A case of a successful post-transcatheter aortic valve replacement His bundle pacing. World J Emerg Med, 2021, 12(2): 157-159.

West China Medical Journal

Research status of cardiac conduction block after transcatheter aortic valve replacement

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