Mechanistic Insights Into Post-TAVR Atrioventricular Block

Heart block is one of the more frequent adverse events of aortic valve replacement therapy, in both surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry report a 30-day permanent pacemaker (PM) implantation rate of 11.3%, with extensive site-level variation (0%-36%). Current guidance from the 2020 American College of Cardiology Expert Consensus Decision Pathway recommends PM implantation for symptomatic bradycardia or complete heart block (CHB) and monitoring with consideration of electrophysiology study (EPS) for new or progressive conduction disturbances. Yet more than 2 decades after the introduction of TAVR, uncertainty remains regarding which conduction changes truly warrant permanent pacing, and different strategies have been proposed for conduction disturbance management.