Skip to main content
Log in

Atrioventricular and intraventricular block after transcatheter aortic valve implantation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Aortic stenosis is the most common valvular heart disease in industrialized countries and the most common cause of left ventricular outflow tract (LVOT) obstruction. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for intermediate to high-risk surgical candidates with symptomatic severe aortic stenosis. Conduction system abnormalities, including atrioventricular (AV) and intraventricular (IV) block, are the most common complication of TAVR. In this review, we aim to explore the anatomical issues relevant to atrioventricular block, the relevant clinical and procedural aspects, and the management and long-term implications of AV and IV block.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.

    Article  PubMed  Google Scholar 

  2. O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.

    Article  PubMed  Google Scholar 

  3. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005;26:2714–20.

    Article  PubMed  Google Scholar 

  4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607. https://doi.org/10.1056/NEJMoa1008232.

    Article  PubMed  CAS  Google Scholar 

  5. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. https://doi.org/10.1056/NEJMoa1103510.

    Article  PubMed  CAS  Google Scholar 

  6. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20. https://doi.org/10.1056/NEJMoa1514616.

    Article  PubMed  CAS  Google Scholar 

  7. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376:1321–31.

    Article  PubMed  Google Scholar 

  8. Erdogan H, Kayalar N, Ardal H, et al. Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement. J Card Surg. 2006;21:211–5.

    Article  PubMed  Google Scholar 

  9. Siontis GC, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol. 2014;64:129–40. https://doi.org/10.1016/j.jacc.2014.04.033.

    Article  PubMed  Google Scholar 

  10. Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1:74–81. https://doi.org/10.1161/CIRCINTERVENTIONS.108.780858.

    Article  PubMed  Google Scholar 

  11. Kawashima T, Sato F. Visualising anatomical evidences on atrioventricular conduction system for TAVI. Int J Cardiol. 2014;17:1–6.

    Article  Google Scholar 

  12. 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;131:469–77.

    Article  PubMed  Google Scholar 

  13. Yater WM, Cornell VH. Heart block due to calcareous lesions of the bundle of His: review and report of a case with detailed histopathologic study. Ann Intern Med. 1935;8:777–89.

    Article  Google Scholar 

  14. Lev M. Anatomic basis for atrioventricular block. Am J Med. 1964;37:742–8.

    Article  PubMed  CAS  Google Scholar 

  15. Calvi V, Conti S, Pruiti GP, Capodanno D, Puzzangara E, Tempio D, et al. Incidence rate and predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis. J Interv Card Electrophysiol. 2012;34:189–95. https://doi.org/10.1007/s10840-011-9634-5.

    Article  PubMed  Google Scholar 

  16. Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation. 2017;136:1049–69.

    Article  PubMed  Google Scholar 

  17. Nazif TM, Williams MR, Hahn RT, Kapadia S, Babaliaros V, Rodés-Cabau J, 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;35:1599–607.

    Article  PubMed  Google Scholar 

  18. Urena M, Webb JG, Cheema A, Serra V, Toggweiler S, Barbanti M, 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;7:128–36.

    Article  PubMed  Google Scholar 

  19. 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;127:1300–7.

    Article  PubMed  Google Scholar 

  20. Nuis RJ, Van Mieghem NM, Schultz CJ, Tzikas A, Van der Boon RM, Maugenest AM, et al. Timing and potential mechanisms of new conduction abnormalities during the implantation of the Medtronic CoreValve System in patients with aortic stenosis. Eur Heart J. 2011;32:2067–74.

    Article  PubMed  Google Scholar 

  21. Schymik G, Tzamalis P, Bramlage P, Heimeshoff M, Wurth A, Wondraschek R, et al. Clinical impact of a new left bundle branch block following tavi implantation: 1-year results of the tavik cohort. Clin Res Cardiol. 2015;104:351–62.

    Article  PubMed  Google Scholar 

  22. Vernooy K, Verbeek XA, Peschar M, et al. Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J. 2005;26:91–8.

    Article  PubMed  Google Scholar 

  23. Schneider JF, Thomas HE Jr, Kreger BE, McNamara PM, Kannel WB. Newly acquired left bundle-branch block: the Framingham study. Ann Intern Med. 1979;90:303–10.

    Article  PubMed  CAS  Google Scholar 

  24. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini 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;143:398–405.

    Article  PubMed  Google Scholar 

  25. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena 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:e003635. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003635.

    Article  PubMed  Google Scholar 

  26. Carrabba N, Valenti R Migliorini A, Marrani M, Cantini G, Parodi G, Dovellini EV, et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol. 2015;116:125–31. https://doi.org/10.1016/j.amjcard.2015.03.054.

    Article  PubMed  Google Scholar 

  27. Meguro K, Lellouche N, Yamamoto M, Fougeres E, Monin JL, Lim P, et al. Prognostic value of QRS duration after transcatheter aortic valve implantation for aortic stenosis using the CoreValve. Am J Cardiol. 2013;111:1778–83. https://doi.org/10.1016/j.amjcard.2013.02.032.

    Article  PubMed  Google Scholar 

  28. Aktug O, Dohmen G, Brehmer K, Koos R, Altiok E, Deserno V, et al. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol. 2012;160:26–30.

    Article  PubMed  Google Scholar 

  29. Katsanos S, van Rosendael P, Kamperidis V, van der Kley F, Joyce E, Debonnaire P, et al. Insights into newonset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation. Am J Cardiol. 2014;114:1556–61.

    Article  PubMed  Google Scholar 

  30. Bernardi FL, Ribeiro HB, Carvalho LA, Sarmento-Leite R, Mangione JA, Lemos PA, et al. Direct transcatheter heart valve implantation versus implantation with balloon predilatation: insights from the Brazilian Transcatheter Aortic Valve Replacement Registry. Circ Cardiovasc Interv. 2016;9:e003605.

    Article  PubMed  Google Scholar 

  31. Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, et al. Permanent pacemaker insertion after corevalve transcatheter aortic valve implantation: incidence and contributing factors (the UK corevalve collaborative). Circulation. 2011;123:951–60.

    Article  PubMed  CAS  Google Scholar 

  32. Sager SJ, Damluji AA, Cohen JA, Shah S, O’Neill BP, Alfonso CE, et al. Transient and persistent conduction abnormalities following transcatheter aortic valve replacement with the Edwards-Sapien prosthesis: a comparison between antegrade vs. retrograde approaches. J Interv Card Electrophysiol. 2016;47:143–51. https://doi.org/10.1007/s10840-016-0145-2.

    Article  PubMed  Google Scholar 

  33. Khatri PJ, Webb JG, Rodés-Cabau J, Fremes SE, Ruel M, Lau K, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158:35–46. https://doi.org/10.7326/0003-4819-158-1-201301010-00007.

    Article  PubMed  Google Scholar 

  34. Abdel-Wahab M, Mehilli J, Frerker C, Neumann F, Kurz T, Tölg R, et al. Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA. 2014;311:1503–14. https://doi.org/10.1001/jama.2014.3316.

    Article  PubMed  Google Scholar 

  35. Rubín JM, Avanzas P, Del Valle R, et al. Atrioventricular conduction disturbance characterization in transcatheter aortic valve implantation with the CoreValve prosthesis. Circ Car- diovasc Interv. 2011;4:280–6.

    Article  Google Scholar 

  36. 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;9:2189–99. https://doi.org/10.1016/j.jcin.2016.07.026.

    Article  PubMed  Google Scholar 

  37. 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;8:60–9.

    Article  PubMed  Google Scholar 

  38. 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. J Am Coll Cardiol Intv. 2016;9:1269–76.

    Article  Google Scholar 

  39. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51:e1–62.

    Article  PubMed  Google Scholar 

  40. 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;34:2281–329.

    Article  PubMed  Google Scholar 

  41. Sweeney MO, Ellenbogen KA, Casavant D, et al. Multicentre, prospective, randomised safety and efficacy study of a new atrial-based managed ventricular pacing mode (MVP) in dual chamber ICDs. J Cardiovasc Electrophysiol. 2005;16:811–7.

    Article  PubMed  Google Scholar 

  42. Deville B. Pacemaker utilization and ventricular pacing in patients undergoing trans-catheter aortic valve replacement (TAVR) (PPM in TAVR) (Clinicaltrials.gov Identifier NCT02994667). 2018. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02994667.

  43. Meguro K, Lellouche N, Teiger E. Cardiac resynchronization therapy improved heart failure after left bundle branch block during transcatheter aortic valve implantation. J Invasive Cardiol. 2012;24:132–3.

    PubMed  Google Scholar 

  44. Sharma E, Chu AF. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System. J Interv Card Electrophysiol. 2018;51:77–86. https://doi.org/10.1007/s10840-017-0303-1.

    Article  PubMed  Google Scholar 

  45. van der Boon RM, et al. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System. Int J Cardiol. 2013;168(2):1269–73. https://doi.org/10.1016/j.ijcard.2012.11.115.

    Article  PubMed  Google Scholar 

  46. Leong D, Sovari AA, Ehdaie A, Chakravarty T, Liu Q, Jilaihawi H, et al. Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement. J Interv Card Electrophysiol. 2018;52:111–6. https://doi.org/10.1007/s10840-018-0345-z.

    Article  PubMed  Google Scholar 

  47. Beurskens NEG, Tjong FVY, Quast AFBE, Knops RE. Successful replacement of the longest worldwide in situ Nanostim leadless cardiac pacemaker for a Micra Transcatheter Pacing System. J Interv Card Electrophysiol. 2018;51:161–2. https://doi.org/10.1007/s10840-017-0310-2.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Thyregod HG, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65:2184–94.

    Article  PubMed  Google Scholar 

  49. Rogers T, Torguson R, Bastian R, Corso P, Waksman R. Feasibility of transcatheter aortic valve replacement in low-risk patients with symptomatic severe aortic stenosis: rationale and design of the Low Risk TAVR (LRT) study. Am Heart J. 2017;189:103–9.

    Article  PubMed  Google Scholar 

  50. Reichenspurner H, Schaefer A, Schäfer U, et al. Self-expanding transcatheter aortic valve system for symptomatic high-risk patients with severe aortic stenosis. J Am Coll Cardiol. 2017;70:3127–36.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vaikom S. Mahadevan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.J., Goldschlager, N. & Mahadevan, V.S. Atrioventricular and intraventricular block after transcatheter aortic valve implantation. J Interv Card Electrophysiol 52, 315–322 (2018). https://doi.org/10.1007/s10840-018-0391-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-018-0391-6

Keywords

Navigation