The ACC on Oct. 21 released the 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement in the Journal of the American College of Cardiology.

Led by Writing Committee Chair Scott M. Lilly, MD, PhD, FACC, the document spotlights the frequent occurrence of conduction disturbances of the heart for patients who require a permanent pacemaker after TAVR. The authors review existing data and experiences regarding the management of conduction disturbances after TAVR and propose an evidence-based expert consensus decision pathway for management.

Specifically, the new pathway includes guidance for managing pre-TAVR, intraprocedural-TAVR and post-TAVR patients. The pathway "is intended to be employed in the clinic during the initial evaluation of patients, in planning meetings, and in preprocedural areas prior to TAVR," the authors explain. Further, it is intended to assist in length-of-stay decisions and planning for safe discharge.

As there are varied practice patterns in terms of the approaches to post-TAVR conduction disturbances, the authors note that "this tool can permit uniformity across providers and systems in the care of these patients."

They add that in many cases, "there remains uncertainty regarding the manner in which conduction block should be managed after TAVR, and clinical judgement is foundational."

Moving forward, as more data become available, appropriate management of patients with transient and/or new conduction disturbances will likely be clarified. "As we await these trials, it is our hope that this document will assist care teams in the management of these patients," the authors conclude.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, Cardiac Surgery and Arrhythmias

Keywords: Transcatheter Aortic Valve Replacement, Pacemaker, Artificial, Heart Block, Electrocardiography, Heart Conduction System

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