EP Fellows Curriculum: Management of Peri-Procedural AV Block-EP Fellows Curriculum: Management of Peri-Procedural AV Block

Video Transcription

Video Summary

In today's talk, the speaker discusses the management of AV block in several different medical procedures. He first highlights the management of periprocedural AV block after catheter ablation. He mentions that av node re-entry is the most common arrhythmia encountered during ablation, and the risk of permanent AV block is about 1 in 500. He recommends systematic vigilance and quick cessation of radiofrequency delivery if JA block is observed. The speaker then transitions to AV block after cardiac surgery, noting that it is particularly common after aortic valve surgery and septal myomectomy procedures. He explains that calcium displacement, edema, and hemorrhage can all contribute to conduction system damage in these cases. The speaker emphasizes the importance of waiting five to seven days after surgery before considering a pacemaker implant, as many cases of AV block resolve spontaneously during this time. Finally, the speaker discusses AV block after transcatheter aortic valve replacement, or TAVR. He explains that the risk of AV block is higher with self-expanding valves than with balloon-expanded valves, and that pre-existing conduction system abnormalities are also a risk factor. He proposes a management approach for post-TAVR patients, including consideration of ambulatory monitoring and EP studies for risk stratification. The speaker concludes by highlighting several remaining questions in this field, and suggests that the placement of pacemakers prior to certain procedures, such as TAVR, should be explored further.

Keywords

AV block

management

medical procedures

catheter ablation

cardiac surgery

aortic valve surgery

septal myomectomy

conduction system damage

pacemaker implant

TAVR