Predictors of high‐degree conduction disturbances and pacemaker implantation after transcatheter aortic valve replacement: Prognostic role of the electrophysiological study

Background Predictors of high‐degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) are recognized, but the electrophysiological study's (EPS) role is still a subject to debate. The objective of our study was to determine factors associated with PPM implantati...

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Published in:Pacing and clinical electrophysiology 2021-05, Vol.44 (5), p.843-855
Main Authors: Ferreira, Thomas, Da Costa, Antoine, Cerisier, Alexis, Vidal, Nicolas, Guichard, Jean Baptiste, Romeyer, Cécile, Barthelemy, Jean Claude, Isaaz, Karl
Format: Article
Language:English
Subjects:
Aged, 80 and over
Aortic valve
atrioventricular block
Atrioventricular Block - etiology
Atrioventricular Block - physiopathology
Atrioventricular Block - therapy
bundle branch block
Cardiac Conduction System Disease - etiology
Cardiac Conduction System Disease - physiopathology
Cardiac Conduction System Disease - therapy
Conduction
Electrophysiologic Techniques, Cardiac
Electrophysiological recording
electrophysiology study
Female
Heart
Humans
Male
Multivariate analysis
pacemaker
Pacemaker, Artificial
Pacemakers
Postoperative Complications - etiology
Postoperative Complications - physiopathology
Postoperative Complications - therapy
Prognosis
Prospective Studies
Risk Assessment
transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement
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Summary:Background Predictors of high‐degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) are recognized, but the electrophysiological study's (EPS) role is still a subject to debate. The objective of our study was to determine factors associated with PPM implantation including the potential role of EPS before and/or after TAVR. Methods and results Seventy four consecutive patients (pts) were included and 21 pts (28.4%) received a PPM during the immediate postoperative follow‐ups (until Day 5): HAVB in 15 pts (71.4%), prophylactic implantation due to a documented increased HV interval ≥ 95–100 ms plus LBBB in 2 pts (9.5%), a high‐degree HV block evidenced at the EPS plus LBBB in 3 pts (14.3%) and one additional patient was implanted for AV‐block in presence of AFib (4.8%). In the multivariate model 1 including parameters before TAVR, both prosthesis diameter and PR lengthening remained significantly associated with PPM as well RBBB. In the multivariate model 2 including parameters after TAVR, only HV remained significantly associated with the risk of PPM (OR = 1.15 (1.05–1.26), p = .004). When all the significant variables in models 1 and 2 were analyzed together in model 3, only HV after TAVR remained significantly associated with an increased risk of PPM. Conclusions In this prospective observational study, it was revealed that a Day 4–5 EPS is likely to more precisely stratify the risk of PPM implantation regarding its ability to discover asymptomatic severe infra‐hisian conduction disturbances particularly in presence of LBBB. Multivariate analysis confirmed the prognostic value of HV alteration.
ISSN:0147-8389
1540-8159
DOI:10.1111/pace.14225