TY - JOUR

T1 - Immediate Post-Procedural 12-Lead Electrocardiography as Predictor of Late Conduction Defects After Transcatheter Aortic Valve Replacement

AU - Jørgensen, Troels H.

AU - De Backer, Ole

AU - Gerds, Thomas A.

AU - Bieliauskas, Gintautas

AU - Svendsen, Jesper H.

AU - Søndergaard, Lars

PY - 2018/8/13

Y1 - 2018/8/13

N2 - Objectives The aim of this study was to use a 12-lead electrocardiogram obtained immediately post–transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR. Background There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR. Methods A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR. Results Self-expandable, mechanical, or balloon-expandable heart valves were implanted in 328 (70%), 61 (13%), and 78 (17%) patients, respectively. For patients in sinus rhythm without right bundle branch block, late HD-CD developed in 0 of 70 patients (0%; 95% confidence interval [CI]: 0% to 5.1%) with PR interval <200 ms and QRS interval <120 ms and in 5 of 109 patients (4.6%; 95% CI: 1.5% to 10.4%; all with sufficient escape rhythm) with PR interval <240 ms and QRS interval <150 ms. Late HD-CD developed in 14 of 101 patients (13.9%; 95% CI: 7.8% to 22.2%; 6 with insufficient escape rhythm [5.9%; 95% CI: 2.2% to 12.5%]) with PR interval ≥240 ms or QRS interval ≥150 ms. Furthermore, late HD-CD developed in 3 of 49 patients (6.1%; 95% CI: 1.3% to 16.9%; all with sufficient escape rhythm) and in 3 of 30 patients (10.0%; 95% CI: 2.1% to 26.5%; 2 with insufficient escape rhythm [6.7%; 95% CI: 0.8% to 22.1%]) with atrial fibrillation and no right bundle branch block with QRS interval <140 and ≥140 ms, respectively. Conclusions On the basis of immediate post-TAVR 12-lead electrocardiography, removing the temporary pacemaker immediately following TAVR is potentially safe in patients without right bundle branch block who are: 1) in sinus rhythm with PR interval <240 ms and QRS interval <150 ms; or 2) in atrial fibrillation with a QRS interval <140 ms.

AB - Objectives The aim of this study was to use a 12-lead electrocardiogram obtained immediately post–transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR. Background There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR. Methods A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR. Results Self-expandable, mechanical, or balloon-expandable heart valves were implanted in 328 (70%), 61 (13%), and 78 (17%) patients, respectively. For patients in sinus rhythm without right bundle branch block, late HD-CD developed in 0 of 70 patients (0%; 95% confidence interval [CI]: 0% to 5.1%) with PR interval <200 ms and QRS interval <120 ms and in 5 of 109 patients (4.6%; 95% CI: 1.5% to 10.4%; all with sufficient escape rhythm) with PR interval <240 ms and QRS interval <150 ms. Late HD-CD developed in 14 of 101 patients (13.9%; 95% CI: 7.8% to 22.2%; 6 with insufficient escape rhythm [5.9%; 95% CI: 2.2% to 12.5%]) with PR interval ≥240 ms or QRS interval ≥150 ms. Furthermore, late HD-CD developed in 3 of 49 patients (6.1%; 95% CI: 1.3% to 16.9%; all with sufficient escape rhythm) and in 3 of 30 patients (10.0%; 95% CI: 2.1% to 26.5%; 2 with insufficient escape rhythm [6.7%; 95% CI: 0.8% to 22.1%]) with atrial fibrillation and no right bundle branch block with QRS interval <140 and ≥140 ms, respectively. Conclusions On the basis of immediate post-TAVR 12-lead electrocardiography, removing the temporary pacemaker immediately following TAVR is potentially safe in patients without right bundle branch block who are: 1) in sinus rhythm with PR interval <240 ms and QRS interval <150 ms; or 2) in atrial fibrillation with a QRS interval <140 ms.

KW - conduction defect

KW - electrocardiogram

KW - pacemaker

KW - transcatheter aortic valve replacement

U2 - 10.1016/j.jcin.2018.04.011

DO - 10.1016/j.jcin.2018.04.011

M3 - Journal article

C2 - 30093055

VL - 11

SP - 1509

EP - 1518

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

SN - 1936-8798

IS - 15

ER -