Evaluation of recent algorithm proposed for the management of conduction disturbances after transcatheter aortic valve implantation: A single-centre retrospective study

Introduction Despite the improvement of transcatheter aortic valve implantation (TAVI) over the last decade, conductive disturbances remain the most frequent complication. Their management is highly variable among centres but an expert consensus has been recently proposed. Objective To evaluate the management of conduction disturbances after TAVI at Rouen University Hospital according to this expert consensus. Method We retrospectively included patients who underwent a TAVI between January 1st, 2017 and December 31st, 2018 at Rouen University Hospital. Patients who had a pacemaker before TAVI were excluded. ECG before, immediately after and the first two days after TAVI were analysed and patients were followed annually. According to the expert consensus, patients were classified in 5 groups: group 1 (normal ECG and no modification after TAVI), group 2 (pre-implantation right bundle branch block without modification after TAVI), group 3 (PR or QRS enlargement > 20 ms with preexisting conductive disturbances), group 4 (new onset left bundle blanch block), group 5 (High degree atrioventricular block [HAVB] or complete heart block [CHB]). The concordance rate in the five groups was evaluated. Results In total, 348 patients were included. The concordance rate was very high (96%) only in group 1. In contrast, the concordance rates were only 50%, 62%, 69% and 37% in groups 2 to 5, respectively. In groups 2, 3 and 4, the main reason of discordance was a shorter telemetry monitoring than recommended (24 hours versus 48 hours). However, only one patient was re-admitted for pacemaker implantation at day 371. In group 5, the main reason of discordance was a too early implantation of pacemaker (day 0 versus day 1). However, all patients except one presenting recurrent ventricular stimulation suggesting recurrent HAVB or CHB. Conclusion The results of this study show frequent but minor discordances between our management of post-TAVI conductive disturbances and the expert consensus.