Effects and Safety of Beta-Blocker Withdrawal Among Patients Undergoing Transcatheter Aortic Valve Replacement

Introduction: Transcatheter aortic valve replacement (TAVR) is associated with increased rates of high degree atrio-ventricular block (HAVB), and peri-procedural atrial fibrillation (AF). We sought to determine whether beta-blocker discontinuation prior to the procedure, affect the rates of HAVB and/or AF.

Methods: Patients who underwent TAVR between March/2009 and April/2017 in two high-volume tertiary Israeli centers, were divided into two groups; in one, beta-blockers therapy was continued, while in the other group, it was stopped prior to the procedure. Our primary outcome was the development of HAVB and/or peri-procedural AF.

Results: A total of 743 consecutive patients were receiving beta-blockers therapy prior to the procedure. Beta-blockers therapy was discontinued in 377 (50.7%) patients, while 366 (49.3%) continued to use beta-blockers prior to the -procedure. There was no difference in the rate of HAVB between the groups (15% vs 12% respectively, p=0.143). In multivariate analysis, discontinuation of beta-blockers was not associated with lower rates of advanced conduction disorders (OR=1.66; 95% CI 0.97-2.83; p=0.07). Peri-procedural AF (new episode of AF in patients with previous AF or new onset AF) occurred more frequently in patients whom beta-blockers was discontinued (14% vs 6%, respectively; p<0.001). In a multivariate analysis, discontinuation of beta-blockers was the only significant predictor for peri-procedural AF (OR=2.20; 95% CI 1.28-3.77; p=0.001).

Conclusion: Beta-blockers discontinuation prior to TAVR did not influence the rate of HAVB development, however, it resulted in increased rates of peri-procedural AF. We, therefore, recommend avoiding discontinuation of beta-blockers in patients undergoing TAVR.