# Conduction Disorders: The Achilles’ Heel of TAVR?

## TL;DR

This review explores the causes and risk factors for conduction disorders after TAVR and suggests strategies to reduce complications and improve pacemaker use.

## Contribution

The paper provides a narrative review summarizing strategies to anticipate and manage conduction disorders after TAVR.

## Key findings

- Conduction disorders remain a major complication of TAVR despite a modest decline in incidence.
- ECG evaluation and MSCT analysis are important for assessing conduction disorder risk.
- Ambulatory monitoring and machine learning may offer future improvements in managing conduction disorders.

## Abstract

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.