Arrhythmias & electrophysiologyCohort study
Rapid Atrial Pacing-Induced Wenckebach Atrioventricular Block: A Poor Predictor of Permanent Pacemaker Need Post-TAVR
- prospective, investigator-initiated, multicenter study
- 12 centers
Authors' conclusion
RAP-induced W-AVB demonstrates limited utility in predicting post-TAVR PPI or sudden cardiac death, particularly in patients at high risk for PPI. Clinicians should be cautious when using this test for post-TAVR rhythm management.
Study context
- Population
- Patients undergoing transcatheter aortic valve replacement (TAVR)included across 12 centers, rapid atrial pacing (RAP) successfully performed post-TAVR in 556
- Participants
- 640 patients
- Exposure
- RAP-induced Wenckebach atrioventricular block (W-AVB) as a diagnostic test for predicting permanent pacemaker implantation (PPI) or sudden cardiac death within 30 days post-TAVR
- W-AVBn = 192
- Outcome
- Sudden cardiac death or guideline-based indications for PPI (Class I and Class II)
- Follow-up
- Within 30 days post-TAVR
Main finding
As reported in the abstract
Odds ratio
1.80
95% CI 1.06–3.04
P = 0.029
By group
W-AVB vs no W-AVB
odds ratio 1.80 (95% CI 1.06–3.04); P = 0.029
- negative predictive value of absence of W-AVB
- 90.7%
- negative likelihood ratio
- 0.79
Observational data: associations, not effects.
Further findings
| Outcome | odds ratio (95% CI) | |
|---|---|---|
| Primary end point, self-expanding valve recipients (subgroup) | 1.47 (0.84–2.58) | |
| Primary end point, baseline or new left bundle branch block (subgroup) | 1.14 (0.54–2.42) | |
| 0.20.5125Odds ratio (log scale) |
- Primary end point, self-expanding valve recipients (subgroup) — negative predictive value
- 88.4%
- Primary end point, self-expanding valve recipients (subgroup) — negative likelihood ratio
- 0.86
- Primary end point, baseline or new left bundle branch block (subgroup) — negative predictive value
- 81.3%
- Primary end point, baseline or new left bundle branch block (subgroup) — negative likelihood ratio
- 0.95
RAP-induced W-AVB post-TAVR
- W-AVB observed in patients with successful post-TAVR RAP
- 192 (34.5%)
- W-AVB associated with baseline conduction disturbances, amiodarone use, pre-TAVR RAP-induced W-AVB, and anesthesia type
Original publication
Rapid Atrial Pacing-Induced Wenckebach Atrioventricular Block: A Poor Predictor of Permanent Pacemaker Need Post-TAVR. Circ Cardiovasc Interv. Published 26 March 2026. doi:10.1161/circinterventions.125.016145
Summarised from the published abstract; every number is checked against it