Conduction Disorders in TAVR: Is Colchicine Useful?

TAVR has shown significant benefit and is increasingly used in severe aortic stenosis, especially in lower risk patients. However, new conduction disorders or the need for pacemaker (PM) implantation following TAVR remains a challenge to be solved. 

Even though implantation techniques have been optimized, especially with self-expanding valves and the need for PM has dropped, this complication persists, in addition to new conduction disorders.

A cohort of 52,860 patients undergoing TAVR between January 2013 and November 2024 was analyzed. 705 of these patients received colchicine.

Colchicine was given prior procedure in doses commonly prescribed for pericarditis, gout flares or periodic fever syndrome. Patients who had received colchicine within 3 months prior TAVR, were excluded. 

The primary outcome was a composite of new complete AV block or worsening, new left bundle branch block (LBBB) or any other conduction block, assessed at 30 days and 6 months. 

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Propensity Score Matching was used to compensate for heterogeneity, leaving 702 patients in each group. 

Mean age was 77, and more than 60% of patients were men. Hypertension prevalence of was 82%, diabetes 44%, atrial fibrillation 40%, first grade A-V block 40%, second grade A-V block 1.8%, LBBB 10% and other blocks or complete right BBB 8%.

The primary outcome resulted lower in patients receiving colchicine at 30 days (34.3% vs. 39.6%; RR 0.867 [CI 95% 0.756–0.994]; p=0.041), both for any block and specifically for LBBB. Similarly, there was reduced incidence of any block (41.5% vs. 46.7%; RR 0.887 [CI 95% 0.788–0.999]; p=0.047). However, at 6 months there were no significant differences.  

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Neither were there differences as regards temporary or permanent PM implantation, high grade AV block, RBBB, hemodynamic instability, atrial fibrillation, new arrhythmias or mortality. 

Conclusion

The use of preoperative colchicine was associated to lower incidence of new or worse AV block, new LBBB or complete AV block one month after TAVR. However, there were no differences at 6 months. More prospective studies are required to assess the role of colchicine for better TAVR evolution.

Original Title: Preoperative Colchicine and Conduction Disturbances After Transcatheter Aortic Valve Implantation: A US Retrospective Cohort Analysis. 

Reference: Kerollos Abdelsayed, et al. J Am Heart Assoc. 2025;14:e043791. DOI: 10.1161/JAHA.125.043791 1.