Valvular & structural heart disease
Risk of delayed atrioventricular block in patients without procedural conduction disturbances during transcatheter aortic valve replacement
Authors' conclusion
Among TAVR recipients with no procedural CDs, those with a preexisting abnormal ECG represent a high-risk group for delayed AVB requiring PPI. This would support a tailored strategy, with a minimalist approach (same- or next-day discharge) in low-risk patients and a more prolonged hospitalization or continuous ECG ambulatory monitoring in those at higher risk.
Study context
- Population
- Patients without a prior pacemaker undergoing transcatheter aortic valve replacement (TAVR), with no prior right bundle branch block and no procedural conduction disturbances334 (49.5%) with baseline electrocardiographic (ECG) abnormalities
- Participants
- 675 patients
- Exposure
- Analyzed overall and according to the preprocedural electrocardiographic (ECG) abnormalities
- Abnormal ECGs preprocedurallyn = 334
- Outcome
- Delayed AVB
- Follow-up
- 30 days
Methodological detailsconsecutive patients, prespecified strategy for managing conduction disturbances (CDs)
- Consecutive patients
- Prespecified strategy for managing CDs
Main finding
As reported in the abstract
P < 0.001
- Delayed atrioventricular block (AVB) overall
- 23 patients (3.4%)
Observational data: associations, not effects.
Further findings
Factors associated with increased risk of delayed AVB (multivariable analysis)
| Comparison | Odds ratio (95% CI) | P value | |
|---|---|---|---|
| Preexisting abnormal ECGMultivariable analysis | 5.28 (1.53–18.27) | P = 0.009 | |
| Left ventricular ejection fraction < 50%Multivariable analysis | 4.17 (1.75–9.93) | P = 0.001 | |
| 0.050.21520Odds ratio (log scale) |
Timing of delayed AVB
- Delayed AVB occurring on day 1 or 2 after the procedure
- 74%
Permanent pacemaker implantation (PPI) rate among patients in sinus rhythm with a preprocedural abnormal ECG (subgroup)
- QRS duration > 120 ms and first-degree AVB (highest risk)
- 17.8%
- Isolated QRS duration > 120 ms
- 8.7%
Original publication
Summarised from the published abstract; every number is checked against it