Little over a year ago, JACC published the expert consensus on the management of post transcatheter aortic valve replacement (TAVR) conduction disturbances. This publication homogenized criteria and was welcomed by operators who, when in doubt, tended to prematurely indicate definite pacemaker implantation or delayed discharge in order to monitor patients.
These criteria, however, was nothing but expert consensus to be validated over time, especially in the daily clinical practice.
This analysis was based on a registry that classified patients using the consensus algorithm: patients eligible for early discharge (1 or 2 days after TAVR); patients at high risk of high degree atrioventricular block who require additional monitoring; and patients with pacemaker indication.
Primary end point was pacemaker implantation rate for high degree or complete block at 30 days. All patients with prior pacemaker, valve in valve or electrocardiogram were excluded.
Of 1439 patients undergoing TAVR between 2014 and 2019, 73% were eligible for early discharge, 21% were at high risk of complete block and the remaining 6% required pacemaker implantation.
Pacemaker implantation rate 30 days after TAVR was 16% (234 patients). 2.7% of the group eligible for early discharge finally required a pacemaker within 30 days after TAVR, and so did 41% of the high-risk group and 100% of those with pacemaker indication.
The expert consensus on post TAVR conduction disturbances was able to safely identify patients needing a pacemaker. This strategy allows a more uniform management, facilitates early discharge of low-risk patients, and prevents prolonging unnecessary monitoring 3 out of 4 patients.
Reference: Daniel Malebranche et al. J Am Coll Cardiol Intv. 2021 May, 14 (9) 981–991.