Key result
Intraprocedural atrioventricular block was significantly associated with severely impaired AV conduction at follow-up in patients who received a pacemaker after TAVI (OR 3.56).
Why the study?
AV conduction disturbances requiring PPI are common after TAVI, but many patients may recover conduction, highlighting the need to evaluate recovery via Wenckebach point measurement to avoid unnecessary RV pacing.
Does Wenckebach point determination identify AV conduction recovery in patients with permanent pacemakers after TAVI to guide device reprogramming?
Observational (n=43)
No
Does Wenckebach point determination identify AV conduction recovery in patients with permanent pacemakers after TAVI to guide device reprogramming?
A significant proportion of patients requiring a pacemaker after TAVI recover AV conduction, and Wenckebach point determination can identify those who may benefit from device reprogramming to minimize unnecessary right ventricular pacing.
Answers are grounded in this paper and cite their sources.
Intraprocedural AV block may predict persistent impairment after TAVI pacemaker; leaves open whether Wenckebach testing can guide safe reprogramming.
Background Atrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up. Objectives The aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing. Methods We enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination. Results A total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and patients with valid AV conduction (WP ≥ 100; 17). In the first group patients had a significantly higher number of intraprocedural atrioventricular block (AVB) (20 vs. 1, p < 0.005), showed a significant higher implantation depth in LVOT (7.7 ± 2.2 vs. 4.4 ± 1.1, p < 0.05) and lower ΔMSID (−0.28 ± 3 vs. −3.94 ± 2, p < 0.05). Conclusion AV conduction may recover in a significant proportion of patients. In our study, valve implantation depth in the LVOT and intraprocedural AV block are associated with severely impaired AV conduction. Regular PM interrogation and reprogramming are required to avoid unnecessary permanent right ventricular stimulation in patients with AV conduction recovery.
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Pelargonio et al. (2022) conducted an observational in Severe aortic stenosis requiring TAVI and permanent pacemaker implantation (n=43). Intraprocedural atrioventricular block vs. No intraprocedural atrioventricular block was evaluated on Severely impaired AV conduction (Wenckebach point < 100 or no spontaneous valid rhythm) (OR 3.56, 95% CI 1.33-9.56, p=0.01). Intraprocedural atrioventricular block was significantly associated with severely impaired AV conduction at follow-up in patients who received a pacemaker after TAVI (OR 3.56).
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