Complete heart block occurs in approximately 15% of patients within 30 days of undergoing a transcatheter aortic valve replacement (TAVR) procedure, leading to the implantation of a permanent pacemaker (PPM). The frequency of in-hospital PPM implantation before discharge has remained constant over the years, but it is becoming more and more common in those first 30 days after discharge.

With this trend in mind, a team of representatives from the American College of Cardiology (ACC) has crafted a new guidance focused on the management of conduction disturbances in TAVR patients.

“Although sustained complete atrioventricular (AV) heart block is a clear indication for PPM, there is no consensus about the management of new bundle branch or transient complete AV heart block,” wrote Scott M. Lilly, MD, chair of the writing committee behind the guidance, and colleagues. “Accordingly, practice patterns are heterogeneous, ranging from prolonged monitoring to electrophysiological testing or even pacemaker implantation for less stringent indications. In some cases, PPMs have been associated with increased short- and long-term mortality, possibly owing to the inherent conduction abnormality or a feature associated with the pacemaker implantation itself. These issues have ramifications for the aggregate cost and quality of life improvements ascribed to TAVR.”