Conduction Disturbances and Permanent Cardiac Pacing after Transcatheter Aortic Implantation (TAVI) - An Update Overview

Aortic valve replacement is a routine procedure with acceptable risk. In some cases, mortality is high, contraindicating the procedure. The minimally invasive transcatheter aortic valve implantation seems to be an alternative, reducing morbidity and mortality. In this procedure, a bioprosthetic valve is introduced through a catheter and fixed within the injured native aortic valve. Even though the technique is considered comparatively safe, the risks of complications exist and they that have been established by individuals after the technique, for example new-onset permanent left bundle branch block (LBBB) and the need for permanent cardiac pacing implantation. A systematic review of literature of PUBMED was carried out using “10 years” and “free full texts” as filters, containing the terms “TAVI,” “pacing,” and “complications,” finding a total of eight articles. Other databases, such as SCIELO, Google Scholar and MEDLINE were used to give background, consistency, and profundity to the text. The implantation of aortic valve prosthesis per catheter seems to be a valid modality for high–surgical risk patients with aortic stenosis. The results of this series of patients suggest that the need for a definitive pacemaker after endovascular treatment is not inexorable and is not easily predicted by the risk factors described so far. TAVI is the procedure of choice considered feasible and safe. Since the site of implantation of the valve prosthesis is close to septal cardiac structures with important function, conduction disorders are frequent, requiring cautious surveillance for at least seven days after the procedure. A lack of consensus and large variability in the management of conduction disturbances post-TAVR exists. Future studies need to validate the proposed algorithm and determine the role of EP studies, ambulatory continuous ECG monitoring, and prophylactic pacemaker in the management of conduction disturbance in post-TAVR patients.