UNC Cardiology Fellow Anthony Mazzella, MD, is first author of a paper published in Cardiac Failure Review. Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalization after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly.
The article recognizes that well-established preprocedural and procedural risk factors can be used to identify and advise high-risk patients and guide management. As the population of patients at increased risk for late presentation of HAVB grows, development of algorithms for extended in-hospital observation or for mobile outpatient cardiac telemetry monitoring post-TAVR, particularly in the first two weeks after discharge, may be needed to reduce the risk of adverse events.