Conduction Disorders: The Achilles’ Heel of TAVR?

High degree conductive disorders (CD) requiring permanent pacemaker implantation (PPI) have modestly decreased over time and remain the main complications of TAVR. Furthermore, management strategies for CD occurring after TAVR remain controversial. We proposed a review evaluating mechanisms and risk of CD after TAVR, focusing on the role of ECG evaluation but also on the importance of anatomic parameters analyzed in multi-slice computed tomography (MSCT), as well as regarding procedural aspects. Considering the lack of clear recommendations for the evaluation of risk of CD and indications of PPI, this review tries to summarize strategies to anticipate and detect the risk of high degree CD, to decrease incidence of CD and to optimize PPI indications. Perspectives regarding ambulatory monitoring, use of machine learning and new pacing techniques are proposed. This review was narrative and included selection of literature using key words including: conductive disorders, TAVR and pacemaker implantation.