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[Transcatheter aortic valve implantation and conduction disturbances].
- Source :
-
Annales de cardiologie et d'angeiologie [Ann Cardiol Angeiol (Paris)] 2019 Dec; Vol. 68 (6), pp. 443-449. Date of Electronic Publication: 2019 Oct 23. - Publication Year :
- 2019
-
Abstract
- Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.<br /> (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Algorithms
Aortic Valve anatomy & histology
Aortic Valve surgery
Atrioventricular Block etiology
Bundle-Branch Block complications
Bundle-Branch Block surgery
Electrocardiography
Heart Block surgery
Heart Conduction System anatomy & histology
Heart Conduction System physiopathology
Heart Valve Prosthesis adverse effects
Heart Valve Prosthesis Implantation adverse effects
Humans
Mitral Valve Stenosis complications
Mitral Valve Stenosis pathology
Pacemaker, Artificial
Aortic Valve pathology
Aortic Valve Stenosis surgery
Calcinosis surgery
Heart Block etiology
Postoperative Complications etiology
Transcatheter Aortic Valve Replacement adverse effects
Subjects
Details
- Language :
- French
- ISSN :
- 1768-3181
- Volume :
- 68
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Annales de cardiologie et d'angeiologie
- Publication Type :
- Academic Journal
- Accession number :
- 31668339
- Full Text :
- https://doi.org/10.1016/j.ancard.2019.09.024