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Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement
Progress in Cardiovascular Diseases ( IF 9.1 ) Pub Date : 2021-07-28 , DOI: 10.1016/j.pcad.2021.06.004
Joshua D Aymond 1 , Francis Benn 1 , Cody M Williams 1 , Michael L Bernard 1 , A Elise Hiltbold 1 , Sammy Khatib 1 , Glenn M Polin 1 , Paul A Rogers 1 , Jose D Tafur Soto 1 , Stephen R Ramee 1 , P Eugene Parrino 1 , Jason B Falterman 1 , Sana M Al-Khatib 1 , Daniel P Morin 1
Affiliation  

Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.



中文翻译:

经导管主动脉瓣置换术后传导障碍的流行病学、评估和管理

主动脉瓣狭窄是最常见的瓣膜病,需要通过手术或经导管方法进行置换。与外科主动脉瓣置换术相比,经导管主动脉瓣置换术 (TAVR) 已迅速成为一种可行且通常首选的治疗策略。然而,经导管心脏瓣膜系统的部署经常会损伤心脏的特殊电气系统,导致新的传导障碍,包括需要永久起搏器植入 (PPI) 的高级别房室传导阻滞和完全性心脏传导阻滞 (CHB),这可能会导致有害影响关于心脏功能和患者预后。额外的传导障碍(例如,新发持续性左束支传导阻滞、PR/QRS 延长、和瞬态 CHB)目前缺乏明确定义的管理算法,导致机构之间的策略不一。本文概述了目前对病理生理学、患者和手术风险因素的理解、对没有明确 PPI 指征的患者进行进一步风险分层和监测的方法、我们的制度方法以及 TAVR 后传导障碍的管理和评估的未来方向.

更新日期:2021-07-28
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