Conduction disturbances after TAVR with newer-generation self-expanding valves

The iteration of transcatheter aortic valve replacement (TAVR) devices along with cumulative technical experiences have substantially contributed to a reduction of periprocedural complications and mortality. Nevertheless, high-degree conduction disturbances (HDCD) requiring permanent pacemaker implantation (PPI) and new-onset left bundle branch block (LBBB) still remain one of most frequent complications after TAVR, especially for self-expandable valves (SEV) [ [1] Auffret V. Lefevre T. Van Belle E. Eltchaninoff H. Iung B. Koning R. et al. Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI. J. Am. Coll. Cardiol. 2017; 70: 42-55 Crossref PubMed Scopus (232) Google Scholar , [2] Auffret V. Puri R. Urena M. Chamandi C. Rodriguez-Gabella T. Philippon F. et al. Conduction disturbances after transcatheter aortic valve replacement. Circulation. 2017; 136: 1049-1069 Crossref PubMed Scopus (276) Google Scholar ]. The rate of PPI after TAVR seems to be different across various types of TAVR prosthesis. Compared with early-generation balloon-expandable valve (BEV), the rate of PPI did not significantly improve with newer-generation balloon-expandable valve (BEV). On the other hand, the rate of PPI has been reduced with the newer-generation of self-expandable CoreValve system [ [3] van Rosendael P.J. Delgado V. Bax J.J. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur. Heart J. 2018; 39: 2003-2013 Crossref PubMed Scopus (163) Google Scholar ]. The pathological relationship between conduction disturbance and implantation depth was based on an anatomic foundation. The His-bundle bifurcates at the inferior border of the membranous septum (MS), with the left bundle emerging beneath the non-coronary cusp. Thus, a smaller difference between the MS length and implantation depth was a strong predictor of new-onset high-degree AVB and PPI after TAVR.