Conduction disturbances after transcatheter aortic valve implantation

Conduction disturbances and permanent pacemaker implantation remain the most common complications after transcatheter aortic valve implantation. The strongest predictors of conduction abnormalities and subsequent permanent pacemaker implantation after transcatheter aortic valve implantation include pre-existing right bundle branch block, a short membranous interventricular septum, deep transcatheter heart valve implantation, and valve type. Importantly, both new permanent pacemaker implantation and new left bundle branch block after transcatheter aortic valve implantation are associated with increased mortality and heart failure hospitalizations. As transcatheter aortic valve indications expand to lower risk and younger populations, with longer life expectancy, strategies to minimize the risk of conduction disturbances and optimize their detection and management become increasingly crucial. Refined transcatheter heart valve implantation techniques may be associated with a reduction in rhythm disturbances after transcatheter aortic valve implantation and anti-inflammatory treatments are under investigation. Ongoing trials are investigating the impact of beta-blocker withdrawal to prevent conduction abnormalities, electrophysiology studies for risk stratification, and conduction system pacing to prevent adverse cardiac remodelling. This review aims to provide an overview of the incidence, pathophysiology, and consequences of conduction disturbances after transcatheter aortic valve implantation, discuss preventive strategies, highlight the relevant ongoing studies, and provide an evidence-based framework for the management of this important clinical issue.