Beta-blocker continuation versus interruption during transcatheter aortic valve implantation: Rationale and design of the BETA-TAVI randomized trial.

Authors

Leonidas Koliastasis, Odysseas Katsaros, Charis Armonis, Nikolaos Ktenopoulos, Spyridon Karpathiotakis, Ioannis Doundoulakis, Iro Ntaga, Dimitrios Tsiachris, Sotirios Tsalamandris, Andreas Synetos, Christos Eftychiou, Vlasios Ninios, Athanasios Trikas, Konstantinos Tsioufis, Konstantinos Toutouzas

Published in

Cardiovascular revascularization medicine : including molecular interventions. Oct 31, 2026. Epub Oct 31, 2026.

Abstract

Beta-blockers are common in patients referred for transcatheter aortic valve implantation (TAVI), but there is no consensus on whether they should be continued through the procedure. Continuation could worsen bradycardia or atrioventricular block in a setting already prone to conduction injury, whereas interruption may provoke adrenergic rebound, tachyarrhythmia, myocardial ischemia, or hemodynamic instability. Available evidence is observational and does not resolve this trade-off.
BETA-TAVI is an investigator-initiated, multicenter, open-label, randomized noninferiority trial in adults with severe symptomatic aortic stenosis undergoing TAVI while receiving chronic oral beta-blocker therapy. Participants are randomized 1:1 to continuation of their usual beta-blocker or interruption from 72 h before TAVI through day 7. The primary endpoint is new permanent pacemaker implantation (PPI) within 7 days. Secondary endpoints include high-degree atrioventricular block, new conduction disturbances, atrial and ventricular arrhythmias, severe bradycardia, hemodynamic deterioration, mortality, and later PPI. The calculated sample size is 348 participants. The prespecified noninferiority margin is 6.5 percentage points on the absolute risk-difference scale; the primary conclusion requires concordant modified intention-to-treat and per-protocol analyses.
BETA-TAVI tests a frequent but poorly studied medication decision using a randomized strategy comparison. The trial will determine whether chronic beta-blocker therapy can be continued through TAVI without a clinically unacceptable increase in early permanent pacing and will characterize the arrhythmic and hemodynamic consequences of both strategies.
gov identifier: NCT05721170.

PMID:
43015211
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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