Article
Author: Makki, Tarek ; Villablanca, Pedro ; Wang, Dee Dee ; Maskoun, Waddah ; Chehab, Omar ; Epstein, Andrew E. ; Raad, Mohamad ; Singh, Gurjit ; O'Neill, Brian ; Epstein, Andrew E ; Lee, James ; Frisoli, Tiberio M. ; Mohammed, Mustafa ; O'Neill, William ; Oudeif, Ahmed ; Abdelrahim, Elsheikh ; Lahiri, Marc ; Ignatius, Abel ; Khan, Arfaat ; Schuger, Claudio ; Wyman, Janet F ; Birchak, John ; Greenberg, Joshua ; Eng, Marvin ; Wyman, Janet F. ; Altawil, Mahmoud ; Frisoli, Tiberio M
Background:There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).
Methods:This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR. The primary outcome was HDAVB requiring pacemaker implantation within 30 days post-TAVR. A separate retrospective cohort was analyzed to determine the postoperative interval at which the risk of HDAVB is reduced to <5%.
Results:HDAVB occurred in 12 (10%) patients. Baseline right bundle branch block (RBBB) (odds ratio [OR]: 13.6), implant depth >4 mm (OR: 3.9), use of mechanically- or self-expanding valves (OR: 6.3), and post-TAVR HV > 65 ms (OR: 4.9) were associated with increased risk of HDAVB, whereas PR intervals and pre-TAVR HV were not. In patients without baseline RBBB or new persistent left bundle branch block (LBBB), not one patient with post-TAVR HV < 65 ms developed HDAVB. In the separate retrospective cohort (N = 1049), the risk of HDAVB is reduced (<5%) on postoperative days 4 and 3 in patients with pre-TAVR RBBB and post-TAVR persistent LBBB, respectively.
Conclusions:Baseline RBBB, new persistent LBBB, implant depth >4 mm, and a post-TAVR HV ≥ 65 ms were associated with a higher risk of post-TAVR HDAVB, whereas an HV ≤ 65 ms was associated with a lower risk. The pre-TAVR HV was not associated with our outcome, and the delta HV did not have practical incremental prognostic value. Among those without pre-TAVR RBBB or post-TAVR persistent LBBB, no patients with post-TAVR HV < 65 ms developed HDAVB.