Minimizing One of Our Major Procedures to a Minimum

In some cases, full atrioventricular (AV) block occurs beyond two days after transcatheter aortic valve replacement (TAVR). This highlights the usefulness of extending monitoring after discharge, particularly in patients who tolerated the procedure well, but meet high-risk criteria.

Minimizando al máximo uno de nuestros mayores procedimientos

We have made great progress regarding conduction disorders in TAVR, especially after the publication of the consensus that unified criteria. However, all blocks that occur beyond 2 days continue to be a challenge.

Two studies recently published in JACC Interventions analyzed the usefulness of electrocardiographic monitoring after discharge.

In one of the papers, up to 4.6% of cases of complete or high-grade AV block within 14 days were diagnosed using ambulatory monitoring. The other study went further in time: after one year of monitoring, 11.9% of cases of complete or high-grade block were identified. In the latter, the device was implantable, with everything that entails.

Post-TAVR ambulatory electrocardiographic monitoring is the most conservative and minimalist option.

The first study included almost 500 patients with no permanent pacemaker who were monitored continuously for 14 days after discharge. Monitoring was performed using two leads, as suggested by the consensus.


Read also: Once Again, the Omicron Variant Tests the Limits of Healthcare Systems, But with Hope.


High-grade or complete block was observed in approximately 1 in 20 patients in the monitored population. Of these, 81% ended up with a permanent pacemaker.

These new disorders were relatively rare (2.2%) in the lower-risk group as defined by the consensus (no changes from the baseline ECG). For those at higher risk (previous right bundle branch block), the rate of block in those 14 days was 13.2%. Finally, the intermediate group (new conduction disorder) reached 8.5%.

No sudden death was recorded within 30 days of implantation.

The other study included 59 patients who underwent an invasive electrophysiological study and, after remaining the first 48 hours of the procedure without conduction disorders, had a recorder implanted for one year.


Read also: Symptomatic Carotid Arteries: Early or Late Emergency Revascularization?


This type of monitoring identified 11.9% of patients with delayed blocks. Of the seven patients who presented conduction disorders, five did so within 8 days of the procedure, while the remaining two developed conduction disorders beyond 3 months.

It is important to note that, in 5 patients, the block could only be diagnosed by the implantable device and not by the surface ECG. The electrophysiological study and the implantable recorder are not cost-effective in the general population undergoing TAVR.

Whether ambulatory monitoring in post-TAVR patients yields protection against events such as sudden death remains to be proven.

Original Title: Ambulatory electrocardiographic monitoring following minimalist transcatheter aortic valve replacement.

Reference: Guillem Muntané-Carol et al. JACC Cardiovasc Interv. 2021 Dec 27;14(24):2711-2722. doi: 10.1016/j.jcin.2021.08.039.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Impact of Iliofemoral Disease on Post TAVR Clinical Outcomes: HOSTILE Score Validation

At present, transcatheter aortic valve replacement (TAVR) has been shown safe and effective for treating severe symptomatic aortic stenosis in high-surgical-risk patients. Moreover, its...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...