Key result
30-day ambulatory event monitoring identified delayed high-grade atrioventricular block in 10% of post-TAVR outpatients without pre-existing pacing devices at a median of 6 days post-procedure.
Why the study?
Delayed high-grade atrioventricular block had not been systematically studied among outpatients after TAVR using latest-generation technology and early discharge.
Cohort (n=150)
No
May support ambulatory monitoring post-TAVR; leaves open optimal selection and duration pending randomized trials.
BACKGROUND High-grade atrioventricular block (H-AVB) is a well-described in-hospital complication of transcatheter aortic valve replacement (TAVR). Delayed high-grade atrioventricular block (DH-AVB) has not been systematically studied among outpatients post-TAVR, using latest-generation TAVR technology and in the early post-TAVR discharge era. OBJECTIVES The purpose of this study was to assess utility of ambulatory event monitoring (AEM) in identifying post-TAVR DH-AVB and associated risk factors. METHODS Patients without pre-existing pacing device undergoing TAVR at the University of Colorado Hospital from October 2016 to March 2018, and who did not require permanent pacemaker implantation pre-discharge, were discharged with 30-day AEM to assess for DH-AVB (≥2 days post-TAVR). Clinical and follow-up data were collected and compared among those without incident H-AVB. RESULTS Among 150 consecutive TAVR patients without a prior pacing device, 18 (12%) developed H-AVB necessitating permanent pacemaker <2 days post-TAVR, 1 died pre-discharge, and 13 declined AEM; 118 had 30-day AEM data. DH-AVB occurred in 12 (10% of AEM patients, 8% of total cohort) a median of 6 days (range 3 to 24 days) post-TAVR. DH-AVB versus non-AVB patients were more likely to have hypertension and right bundle branch block (RBBB). Sensitivity and specificity of RBBB in predicting DH-AVB was 27% and 94%, respectively. CONCLUSIONS DH-AVB is an underappreciated complication of TAVR among patients without pre-procedure pacing devices, occurring at rates similar to in-hospital, acute post-TAVR H-AVB. RBBB is a risk factor for DH-AVB but has poor sensitivity, and other predictors remain unclear. In this single-center analysis, AEM was helpful in expeditious identification and treatment of 10% of post-TAVR outpatients. Prospective study is needed to clarify incidence, risk factors, and patient selection for outpatient monitoring.
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Ream et al. (2019) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=150). 30-day ambulatory event monitoring (AEM) was evaluated on Delayed high-grade atrioventricular block (DH-AVB) ≥2 days post-TAVR. 30-day ambulatory event monitoring identified delayed high-grade atrioventricular block in 10% of post-TAVR outpatients without pre-existing pacing devices at a median of 6 days post-procedure.
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