JACC Scientific Expert Panel Addresses Management of Conduction Disturbances Associated With TAVR

August 27, 2019—In Journal of the American College of Cardiology (JACC), Josep Rodés-Cabau, MD, et al published a JACC scientific expert panel on the management of conduction disturbances associated with transcatheter aortic valve replacement (TAVR; 2019;74:1086–1106).

The document provides an algorithm strategy proposal in the management of conduction disturbances post-TAVR. Future studies are needed to validate the proposed algorithm and determine the role of electrophysiology studies, ambulatory continuous electrocardiogram monitoring, and prophylactic pacemaker in the management of conduction disturbance in post-TAVR patients, noted the panel.

According to the authors, the occurrence of conduction disturbances has not decreased over time and remains the most frequent complication of the procedure, despite major improvements in TAVR periprocedural complications in recent years. Additionally, there has been an important lack of consensus on the management of these complications, which has translated into a high degree of uncertainty regarding the most appropriate treatment of a large proportion of such patients, along with major differences between centers and studies in pacemaker rates post-TAVR. There is, therefore, an urgent need for a uniform strategy regarding the management of conduction disturbances after TAVR.

The present expert consensus scientific panel document has been formulated by a multidisciplinary group of interventional cardiologists, electrophysiologists, and cardiac surgeons as an initial attempt to provide a guide for the management of conduction disturbances after TAVR based on the best available data and group expertise.