Key result
In patients with a new pacemaker after SE-TAVR, 50% had durable AV conduction recovery; larger aortic annular size was negatively associated with recovery (OR 0.53; 95% CI 0.28-0.86; P=0.02).
Why the study?
Heart block requiring a pacemaker is common after SE-TAVR, but conduction abnormalities may improve over time, leaving optimal device management unknown.
What is the long-term natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR?
Cohort (n=40)
No
What is the long-term natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR?
Odds Ratio: 0.53 (95% CI 0.28–0.86)
p-value: p=0.02
Half of patients requiring a pacemaker after SE-TAVR recover AV conduction, highlighting the need for tailored device programming to promote intrinsic conduction.
May support cautious pacemaker programming to favor intrinsic conduction post-SE-TAVR; leaves open annular size as recovery predictor in larger studies.
BACKGROUND: Heart block requiring a pacemaker is common after self-expandable transcatheter aortic valve replacement (SE-TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown. OBJECTIVE: To evaluate the long-term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR. METHODS: All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE-TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow-up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery. RESULTS: Following SE-TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow-up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long-term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28-0.86]/mm, P = 0.02) predicted lack of conduction recovery. CONCLUSIONS: Half of the patients undergoing CIED placement for heart block following SE-TAVR recovered AV conduction within several months and maintained this over an extended follow-up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.
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Ghannam et al. (2019) conducted a cohort in Heart block requiring a pacemaker following SE-TAVR (n=40). Larger aortic annular size was evaluated on Conduction recovery (OR 0.53, 95% CI 0.28-0.86, p=0.02). In patients with a new pacemaker after SE-TAVR, 50% had durable AV conduction recovery; larger aortic annular size was negatively associated with recovery (OR 0.53; 95% CI 0.28-0.86; P=0.02).
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