Predictors of Complete Atrioventricular Block Following Transcatheter Aortic Valve Replacement

Objectives: Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure used for the treatment of aortic valve disease in patients who are considered high-risk or ineligible for traditional open-heart surgery. During the TAVR procedure, various factors can affect the patient's electrical conduction system and disrupt the heart's inherent rhythm. As the frequency of procedure increases, the need for complete atrioventricular (AV) block and permanent pacemaker also increases. These factors encompass the positioning of the transcatheter valve, proximity of the valve to electrical pathways, and manipulation of the catheter within the cardiac structure. The present study aimed to evaluate the relationship between the development of complete AV block after TAVR and possible predictive parameters. Materials and Methods: The study population consisted of 191 consecutive patients undergoing TAVR for severe aortic valve stenosis between January 2021 and June 2022. The baseline clinical characteristics and clinical information were recorded. The patients were divided into two groups according to the development of complete AV block. Multivariate logistic regression analysis was performed to identify the predictors of complete AV block. Results: Among the participants, 13 (6.8%) developed a complete AV block. In the group with complete AV block, the prosthetic valve/aortic annulus ratio was significantly higher (p=0.015). Bradycardia and right bundle branch block (RBBB) on the pre-procedural electrocardiogram were significantly more common (p=0.001) and the AV area was lower (p=0.033) in the complete AV block group. In multivariate logistic regression analysis, preprocedural RBBB was found to be an independent predictor of complete AV block. Preprocedural bradycardia, aortic valve area, and prosthetic valve/ aortic annulus ratio were other independent predictors. Conclusion: Complete AV block after the TAVR procedure is a predictable complication. Larger studies are required to draw more definitive conclusions. Keywords: Transcatheter aortic valve replacement, complete atrioventricular block, pacemaker, right bundle branch block