Management of new-onset left bundle branch block after transcatheter aortic valve implantation: In whom to pace or not to pace?

Abstract

Transcatheter aortic valve implantation (TAVI) has rapidly expanded, and indications have broadened to include patients older than 65 years also eligible for surgical aortic valve replacement. 1 Otto C.M. Nishimura R.A. Bonow R.O. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 143: e72-e227 PubMed Google Scholar New-onset left bundle branch block (LBBB) post-TAVI is the most frequent complication associated with the procedure and has been reported to be associated with a substantial risk of high-grade atrioventricular (AV) block (5%–35%). 2 Khatri P.J. Webb J.G. Rodes-Cabau J. et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013; 158: 35-46 Crossref PubMed Google Scholar The optimal management of new onset LBBB after TAVI remains uncertain. Recent consensus documents have recommended temporary cardiac pacemaker placement in all patients with LBBB for 24–48 hours and using either electrophysiology study (EPS) for risk stratification or prophylactic pacemaker placement in patients with persisting conduction abnormalities. 3 Lilly S.M. Deshmukh A.J. Epstein A.E. 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: 2391-2411 Crossref PubMed Scopus (54) Google Scholar Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter studyHeart RhythmPreviewNew-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block. Full-Text PDF