Conduction Disturbances and Pacing after Transcatheter Aortic Valve Replacement: Mechanisms, Risk Stratification, and Management.

Conduction disturbances are common after transcatheter aortic valve replacement and significantly influence postprocedural management and outcomes. These abnormalities arise from the close anatomic relationship between the aortic annulus and the atrioventricular conduction system, with injury mediated by mechanical compression, edema, ischemia, and delayed remodeling. New-onset left bundle branch block is the most frequent disturbance, while high-grade atrioventricular block often requires permanent pacemaker implantation. Risk stratification is multifactorial and incorporates baseline electrocardiographic abnormalities-particularly right bundle branch block-imaging features such as membranous septum length and left ventricular outflow tract calcification, and procedural factors including implantation depth and valve platform.