Why the study?
The temporal incidence of high-grade atrioventricular block after TAVR is uncertain, leaving periprocedural monitoring and pacing strategies controversial.
What is the temporal incidence and what are the predictors of delayed high-grade atrioventricular block after transcatheter aortic valve replacement?
What is the temporal incidence and what are the predictors of delayed high-grade atrioventricular block after transcatheter aortic valve replacement?
Delayed high-grade AV block after TAVR occurs in approximately 3.7% of patients and is strongly predicted by baseline conduction abnormalities, new LBBB, and the use of self-expanding valves, which can help tailor post-procedural monitoring strategies.
May guide extended monitoring in patients with conduction abnormalities after TAVR; leaves open prospective validation of risk stratification.
Background The temporal incidence of high‐grade atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) is uncertain. As a result, periprocedural monitoring and pacing strategies remain controversial. This study aimed to describe the temporal incidence of initial episode of HAVB stratified by pre‐ and post‐TAVR conduction and identify predictors of delayed events. Methods and Results Consecutive patients undergoing TAVR at a single center between February 2012 and June 2019 were retrospectively assessed for HAVB within 30 days. Patients with prior aortic valve replacement, permanent pacemaker (PPM), or conversion to surgical replacement were excluded. Multivariable logistic regression was performed to assess predictors of delayed HAVB (initial event >24 hours post‐TAVR). A total of 953 patients were included in this study. HAVB occurred in 153 (16.1%). After exclusion of those with prophylactic PPM placed post‐TAVR, the incidence of delayed HAVB was 33/882 (3.7%). Variables independently associated with delayed HAVB included baseline first‐degree atrioventricular block or right bundle‐branch block, self‐expanding valve, and new left bundle‐branch block. Forty patients had intraprocedural transient HAVB, including 16 who developed HAVB recurrence and 6 who had PPM implantation without recurrence. PPM was placed for HAVB in 130 (13.6%) (self‐expanding valve, 23.7% versus balloon‐expandable valve, 11.9%; P <0.001). Eight (0.8%) patients died by 30 days, including 1 unexplained without PPM present. Conclusions Delayed HAVB occurs with higher frequency in patients with baseline first‐degree atrioventricular block or right bundle‐branch block, new left bundle‐branch block, and self‐expanding valve. These findings provide insight into optimal monitoring and pacing strategies based on periprocedural ECG findings.
No takes yet. Share an insight, caveat, or question.
El‐Sabawi et al. (2021) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: