IMR Press / RCM / Volume 23 / Issue 3 / DOI: 10.31083/j.rcm2303090
Open Access Review
Current Opinions on New-Onset Left Bundle Branch Block after Transcatheter Aortic Valve Replacement and the Search for Physiological Pacing
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1 Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 310016 Hangzhou, Zhejiang, China
2 Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, 310016 Hangzhou, Zhejiang, China
*Correspondence: (Jiefang Zhang); (Guosheng Fu)
Academic Editor: Jinnette D. Abbott
Rev. Cardiovasc. Med. 2022, 23(3), 90;
Submitted: 15 December 2021 | Revised: 24 February 2022 | Accepted: 25 February 2022 | Published: 9 March 2022
(This article belongs to the Special Issue Structural Heart Interventions)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Transcatheter aortic valve replacement possesses a high validity for patients with aortic stenosis who are considered high risk for aortic valve replacement surgery, nowadays it is also considered for patients with intermediate risk or even lower risk in certain situations. The incidence of new conduction abnormalities remains to be a tough problem, in particular, left bundle branch block. New-onset left bundle branch block is a major concern despite improvements in valve technology, and it may affect postoperative prognosis. Understanding the anatomical relationship between the conduction system and the aortic root, clarify factors related to the procedure, devices, and patients, might help to reduce the conduction abnormalities. Physiological pacing has emerged as a reasonable pacing strategy for patients with cardiac insufficiency post-valve replacement, especially combined with left bundle branch block. The purpose of this review is to summarize the current opinion on the incidence of new-onset left bundle branch block associated with transcatheter aortic valve replacement, to offer insights into its anatomical and procedural causes, clinical consequences, and more importantly, the prospect of applying physiological pacing as a therapeutic method for these patients.

transcatheter aortic valve replacement
His-purkinje conduction system pacing
left bundle branch block
Fig. 1.
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