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Transcatheter aortic valve replacement (TAVR) with the latest-generation Sapien 3 and Evolut R valves is not uncommonly followed by , one center found.

Three out of the 103 Sapien 3 recipients and one out of the 55 Evolut R recipients returned with late heart block among those getting the procedure at the University of Colorado Hospital in Aurora from July 2015 to November 2016.

Of those four patients requiring a permanent pacemaker, one had syncope and died from intracranial hemorrhage, Ryan Aleong, MD, and colleagues from the center wrote in a research letter published in the Feb. 6 issue of the Journal of the American College of Cardiology.

"Relative to older-generation valves, newer valves show similar inpatient pacemaker implantation rates post-deployment. Importantly, we report the development of high-grade conduction disease after discharge without change in baseline periprocedural conduction. Converse from higher inpatient pacemaker implantation rates seen with self-expanding valves, in this small series, we note similar rates of heart block post-discharge between valve types," the authors noted.

Now Aleong's group does routine real-time ambulatory rhythm monitoring for 30 days with real-time ECG analysis in patients getting TAVR, along with routine follow-up at 1 month.

Since implementation in October 2016, 38 patients have undergone uncomplicated TAVR without the need for post-procedure pacemaker implantation and been discharged with rhythm monitoring. Heart block was identified in seven patients (four with Sapien 3 and three with Evolut R) between days 2 and 24 through ambulatory rhythm monitoring.

Four of those seven patients had no baseline conduction system disease or change between pre-procedure and discharge ECG.

"In this focused work, we describe a concerning signal for post-discharge presentation with heart block in patients undergoing TAVR with newest-generation transcatheter valves. Periprocedural telemetry may not be sufficient to capture all patients at risk of heart block after valve implantation," according to Aleong and colleagues.

They noted that several clinical trials are using implantable rhythm monitors to analyze the long-term risk of conduction system disease in TAVR recipients. "These and further prospective studies incorporating procedural data (e.g., valve position, annular calcification) with short- and long-term rhythm monitoring to detect conduction abnormalities are important next steps in building on the signal shown in this work."

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