PD Dr. med. Thomas Nestelberger

Aortic Stenosis is the most common valvulopathy in the developed world. Approximately, 5% of people over 65 years suffer from aortic stenosis. The slowly progressing manifestation of symptoms, such as syncope, angina, dyspnoea and heart failure, is accompanied by a serious increase in morbidity and mortality. Transcatheter aortic valve replacement (TAVR) is an established and valuable treatment option for patients with both severe symptomatic aortic stenosis and high risk for surgical aortic valve replacement (SAVR). The use of TAVR is rapidly expanding worldwide, and indications widened into low-risk populations as well as into younger patients in view of favourable outcomes in recent data. Patients with severe aortic stenosis often have concomitant heart conditions, making B-blockers a key part of the treatment to reduce mortality and morbidity. The rate of B-Blocker treatment before TAVR is around 34 to 51%. These medications are also used for heart failure, arrhythmias, and coronary artery disease. B-blockers can cause side effects like AV-block, bradycardia, hypotension, and worsen heart failure, especially at higher doses. Permanent pacemaker implantation (PPI) is the most common complication post-TAVR with incidences of 9% to 26% and is linked to mechanical and ischemic impacts on the heart's conduction system. Stopping B-blockers post-TAVR is a common practice aimed at reducing conduction disturbances and the need for PPI, but this approach lacks support from clinical trials or guidelines. B-blockers may increase the risk for permanent pacemaker implantation in TAVR patients, but two observational studies showed no significant difference in PPI rates with their use, while their withdrawal is associated with higher arrhythmic risks. The aim of this clinical trial is to investigate the impact of beta blocker administration among patients undergoing TAVR.