Key result
New left bundle branch block immediately after transcatheter aortic valve implantation strongly predicted the development of high-grade AV block requiring a permanent pacemaker (OR 24.85).
Why the study?
Does surface ECG evaluation immediately after TAVI predict the need for permanent pacemaker implantation in patients with severe aortic stenosis?
Observational (n=45)
No
Does surface ECG evaluation immediately after TAVI predict the need for permanent pacemaker implantation in patients with severe aortic stenosis?
Surface ECG parameters (new LBBB, PQ > 200 ms, QRS > 120 ms) immediately after TAVI strongly predict the need for permanent pacemaker implantation, suggesting intracardiac measurements may not provide incremental value.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI. METHODS: Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done. RESULTS: TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p<0.001), longer AH (153.6±43.4 msec versus 116.1±31.2 msec; p<0.001) and HV interval (81.7±17.8 msec versus 56.8±8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay. CONCLUSION: Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.
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Akın et al. (2012) conducted an observational in Symptomatic aortic valve stenosis (n=45). Transcatheter aortic valve implantation (TAVI) vs. Patients not requiring a pacemaker was evaluated on High-grade AV block (type II second-degree and third-degree) requiring pacemaker (OR 24.85, 95% CI 1.57-392.57, p=0.023). New left bundle branch block immediately after transcatheter aortic valve implantation strongly predicted the development of high-grade AV block requiring a permanent pacemaker (OR 24.85).
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