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  • Review Article
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New conduction abnormalities after TAVI—frequency and causes

Nature Reviews Cardiology volume 9, pages 454–463 (2012)Cite this article

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Abstract

Transcatheter aortic valve implantation (TAVI) is increasingly used to treat patients with aortic stenosis who are considered to be too high-risk for surgical replacement of the aortic valve. Although the procedural risks are decreasing, the occurrence of new conduction abnormalities remains a vexing issue. Both left bundle branch block and atrioventricular dissociation can affect prognosis after TAVI. Understanding the intimate relationship between the atrioventricular conduction axis and the aortic root, in addition to elucidation of factors related specifically to the procedure, devices, and patients, might help to reduce these conduction abnormalities. The purpose of this Review is to assess, and offer insights into, the available information on the frequency of new conduction abnormalities associated with TAVI, their anatomical and procedural causes, and their clinical consequences.

Key Points

  • Transcatheter aortic valve implantation (TAVI) is increasingly used to treat patients with aortic stenosis who are considered to be too high-risk for surgical replacement of the aortic valve

  • Although the procedural risks are decreasing, the occurrence of new conduction abnormalities after TAVI remains a major issue

  • The aggregate of information concerning potential predictors is growing, but a comprehensive overview of these factors is still lacking

  • Knowledge of the intimate relationship and proximity of the atrioventricular conduction axis with the aortic root allows us to understand the pathological mechanisms underlying new conduction abnormalities after TAVI

  • Appreciation of factors related specifically to the devices, procedure, and patients makes it possible to predict the occurrence of new conduction abnormalities, and might change the procedure and devices

  • Information concerning the effects of new conduction abnormalities and new implantation of permanent pacemakers on long-term follow-up is scarce and should be further elucidated

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Figure 1
Figure 2
Figure 3
Figure 4: Anatomy and relationship between the aortic valvular complex and the atrioventricular conduction system.
Figure 5: Commercially available prosthetic aortic valves.
Figure 6: Relationship between the implanted prosthesis and the atrioventricular conduction system.

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Authors and Affiliations

  1. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands

    Robert M. van der Boon, Rutger-Jan Nuis, Nicolas M. Van Mieghem, Luc Jordaens, Ron T. van Domburg, Patrick W. Serruys & Peter P. T. de Jaegere

  2. Quebéc Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, G1V 4G5, QC, Canada

    Josep Rodés-Cabau

  3. Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, NE1 3BZ, Newcastle upon Tyne, UK

    Robert H. Anderson

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Contributions

R. M. van der Boon and R.-J. Nuis researched the data for the article, and all the authors contributed substantially to discussion of its content. R. M. van der Boon, R.-J. Nuis, R. H. Anderson, and P. P. T. de Jaegere wrote the article, and all the authors reviewed or edited the manuscript before submission.

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Correspondence to Peter P. T. de Jaegere.

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Competing interests

J. Rodés Cabau is, or has been, a consultant for Edwards Lifesciences and St Jude Medical. P. P. T. de Jaegere is, or has been, a consultant for Medtronic. The other authors declare no competing interests.

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van der Boon, R., Nuis, RJ., Van Mieghem, N. et al. New conduction abnormalities after TAVI—frequency and causes. Nat Rev Cardiol 9, 454–463 (2012). https://doi.org/10.1038/nrcardio.2012.58

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