Key result
A pre-TAVI HV interval greater than 70 ms was significantly associated with an increased risk of subsequent high-grade atrioventricular block and permanent pacemaker implantation after TAVI (OR 2.53).
Why the study?
Atrioventricular conduction abnormalities after TAVI are common, but the value of electrophysiological study for risk stratification of high-grade atrioventricular block and guidance of permanent pacemaker implantation is poorly defined.
Does invasive electrophysiological testing predict high-grade atrioventricular block and guide permanent pacemaker implantation in patients with equivocal indications after TAVI?
Meta-Analysis (n=1,230)
Does invasive electrophysiological testing predict high-grade atrioventricular block and guide permanent pacemaker implantation in patients with equivocal indications after TAVI?
Odds Ratio: 2.53 (95% CI 1.11–5.81)
p-value: p=0.04
Selective electrophysiological testing can assist in risk stratification for high-grade AV block and guide permanent pacemaker implantation in patients with equivocal indications after TAVI.
EPS may guide PPM decisions in equivocal post-TAVI cases; supports selective use but requires prospective validation.
Background: Atrioventricular conduction abnormalities after transcatheter aortic valve implantation (TAVI) are common. The value of electrophysiological study (EPS) for risk stratification of high-grade atrioventricular block (HG-AVB) and guidance of permanent pacemaker (PPM) implantation is poorly defined. Objective: The purpose of this study was to identify EPS parameters associated with HG-AVB and determine the value of EPS-guided PPM implantation after TAVI. Methods: We performed a systematic review and meta-analysis of studies investigating the value of EPS parameters for risk stratification of TAVI-related HG-AVB and for guidance of PPM implantation among patients with equivocal PPM indications after TAVI. Results: = .02; per 1-ms increase), respectively. In 10 studies, PPM was also implanted due to abnormal EPS findings in patients with equivocal PPM indications post-TAVI (typically new left bundle branch block or transient HG-AVB). Among them, the rate of long-term PPM dependency was 57%. Conclusion: Selective EPS testing may assist in the risk stratification of post-TAVI HG-AVB and in the guidance of PPM implantation, especially in patients with equivocal PPM indications post-TAVI.
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Siontis et al. (2022) conducted a meta-analysis in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=1,230). Pre-TAVI HV interval >70 ms vs. Pre-TAVI HV interval ≤70 ms was evaluated on High-grade atrioventricular block (HG-AVB) and permanent pacemaker (PPM) implantation (OR 2.53, 95% CI 1.11-5.81, p=0.04). A pre-TAVI HV interval greater than 70 ms was significantly associated with an increased risk of subsequent high-grade atrioventricular block and permanent pacemaker implantation after TAVI (OR 2.53).
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