BACKGROUND: Electrophysiological predictors of atrioventricular (AV) block after transcatheter aortic valve replacement (TAVR) are unknown. OBJECTIVE: We sought to assess the value of electrophysiology study before and after TAVR. METHODS: Seventy-five consecutive pacemaker-free patients undergoing TAVR at the Montreal Heart Institute were prospectively studied. RESULTS: Eleven patients (14.7%) developed AV block during the index hospitalization and 3 (4.0%) after hospital discharge over a median follow-up of 1.4 years (interquartile range 0.6-2.1 years). AV block developed in 5 of 6 patients with preprocedural right bundle branch block (83.3%), 8 of 30 patients with new-onset left bundle branch block (LBBB; 26.7%), and 1 of 7 patients with preexisting LBBB (14.3%). In multivariate analysis that considered all patients, the delta-HV interval (HV interval after TAVR minus HV interval before TAVR) was the only factor independently associated with AV block. In the subgroup of patients with new-onset LBBB, the postprocedural HV interval was strongly associated with AV block. By receiver operating characteristic analysis, a delta-HV interval of ≥13 ms predicted AV block with 100.0% sensitivity and 84.4% specificity and an HV interval of ≥65 ms predicted AV block with 83.3% sensitivity and 81.6% specificity. In multivariate analysis, the HV interval after TAVR (hazard ratio 1.073 per ms; 95% confidence interval 1.029-1.119; P = .001) was also independently associated with all-cause mortality. CONCLUSION: A prolonged delta-HV interval (≥13 ms) is strongly associated with AV block after TAVR. In patients with new-onset LBBB after TAVR, a postprocedural HV interval of ≥65 ms is likewise predictive of AV block.
BACKGROUND: Electrophysiological predictors of atrioventricular (AV) block after transcatheter aortic valve replacement (TAVR) are unknown. OBJECTIVE: We sought to assess the value of electrophysiology study before and after TAVR. METHODS: Seventy-five consecutive pacemaker-free patients undergoing TAVR at the Montreal Heart Institute were prospectively studied. RESULTS: Eleven patients (14.7%) developed AV block during the index hospitalization and 3 (4.0%) after hospital discharge over a median follow-up of 1.4 years (interquartile range 0.6-2.1 years). AV block developed in 5 of 6 patients with preprocedural right bundle branch block (83.3%), 8 of 30 patients with new-onset left bundle branch block (LBBB; 26.7%), and 1 of 7 patients with preexisting LBBB (14.3%). In multivariate analysis that considered all patients, the delta-HV interval (HV interval after TAVR minus HV interval before TAVR) was the only factor independently associated with AV block. In the subgroup of patients with new-onset LBBB, the postprocedural HV interval was strongly associated with AV block. By receiver operating characteristic analysis, a delta-HV interval of ≥13 ms predicted AV block with 100.0% sensitivity and 84.4% specificity and an HV interval of ≥65 ms predicted AV block with 83.3% sensitivity and 81.6% specificity. In multivariate analysis, the HV interval after TAVR (hazard ratio 1.073 per ms; 95% confidence interval 1.029-1.119; P = .001) was also independently associated with all-cause mortality. CONCLUSION: A prolonged delta-HV interval (≥13 ms) is strongly associated with AV block after TAVR. In patients with new-onset LBBB after TAVR, a postprocedural HV interval of ≥65 ms is likewise predictive of AV block.
Authors: Nashwa M Abdulsalam; Jeanne E Poole; Elizabeth R Lyden; Arthur J Easley; Gregory S Pavlides; Shane F Tsai; David E Barton Journal: J Interv Card Electrophysiol Date: 2022-09-02 Impact factor: 1.759
Authors: Cláudio Monteiro; Andres Di Leoni Ferrari; Paulo Ricardo Avancini Caramori; Luiz Antonio Ferreira Carvalho; Dimytri Alexandre de Alvim Siqueira; Luiz Eduardo Koenig São Thiago; Marco Perin; Valter C de Lima; Enio Guérios; Fabio Sandoli De Brito Junior Journal: Arq Bras Cardiol Date: 2017-11-27 Impact factor: 2.000
Authors: Lennart van Gils; Didier Tchetche; Thibault Lhermusier; Masieh Abawi; Nicolas Dumonteil; Ramón Rodriguez Olivares; Javier Molina-Martin de Nicolas; Pieter R Stella; Didier Carrié; Peter P De Jaegere; Nicolas M Van Mieghem Journal: J Am Heart Assoc Date: 2017-03-03 Impact factor: 5.501