Volume 32, Nº 5, September and October 2019
DOI: http://www.dx.doi.org/10.5935/2359-4802.20190078
EDITORIAL
Conduction Abnormalities after Transcatheter Aortic Valve Replacement: Pretty Common, Fairly Predictable, Barely Avoidable
Mohammad Abdelghani
The cardiac conduction system is commonly diseased in patients with aortic valve disease, and the site of conduction defect in those with severe calcific aortic valve stenosis is most commonly the His bundle or infra- Hisian.1,2 The bundle of His traverses the membranous septum towards the left ventricular outflow tract (LVOT) running superficially over the crest of the ventricular septum, originating the left bundle branch. This anatomical course makes the His bundle and its left branch susceptible to mechanical injury during transcatheter aortic valve replacement (TAVR), which involves multiple mechanical manipulations with wires, catheters, balloons, and the transcatheter heart valve (THV) inflow within that vicinity. Atrioventricular and intra-ventricular conduction abnormalities are indeed a common finding in patients with severe aortic valve stenosis referred to TAVR and new onset persistente conduction abnormalities (NOPCAs) are a common complication arising during/after TAVR.
Keywords: Aortic Valve Stenosis/complications; Aortic Valve Stenosis/physiopathology; Arrhythmias, Cardiac; Bundle-Branch Block/etiology; Transcatheter Aortic Valve Replacement/adverse effects; Pacemaker, Artificial.
