Evaluation of an expert consensus for the management of conductive disturbances after TAVI: A monocentric retrospective observational study at Rouen university hospital

Atrioventricular conduction disturbances after transcatheter aortic valve implantation (TAVI) remain frequent and are the most common complication. Their management varies between centers and has a significant impact on hospitalization lengths. A consensus of experts has been recently proposed to standardize practices and to reduce their impact on length of hospitalization. To compare our management of post TAVI conduction disturbances with that proposed by this consensus in patients requiring femoral TAVI between 01/01/2017 and 31/12/2018 at Rouen University Hospital. Patients who had a pacemaker or defibrillator before TAVI, and those who died during the procedure were excluded. ECGs before, immediately after and the first two days after TAVI were analyzed and patients were followed for at least two years. According to expert consensus, patients were classified into 5 groups. We retrospectively assessed the concordance between the management performed in our department and that proposed by the consensus. We also studied the impact of the management of conduction disturbances on the length of stay and the outcome of the patients. During the studied period, 346 patients were included. In the overall population, a concordance was observed between our management and that proposed by the consensus in 76% of cases. Concordance was variable among groups and was highest in group 1 and lowest in group 5 (Fig. 1). Patients with a discordance were not rehospitalized for PM implantation and survival was similar to that of patients without a discordance (P = 0.36). According to the consensus management, 80% of patients were eligible for early discharge (i.e., within 48 hours) in the absence of other complications. Early discharge was achieved in 71% of cases. Our study established a perfect concordance of management in about ¾ of the cases. The discordances had no impact on a follow-up of about 2 years. According to this consensus, about 80% of patients are eligible for early discharge. Our results suggest that the decision pathway proposed by the consensus is appropriate and reduces the impact of conduction disturbances on the length of stay.