Journal Article

12 Electrocardiography predictors for pacemaker insertion post TAVR

McAuliffe, E, O’ Connor, SM, O’Sullivan, B, Ranganathan, D, Rady, N, Fahy, F, Kearney, P

2020

Overview

IntroductionThe development of Transcatheter Aortic Valve Replacement (TAVR) has provided an alternative to surgical valve replacement in high-risk population. Post-procedural length of stay is one of the main cost components after TAVR and is significantly influenced by prolonged monitoring for new conduction disturbances. Occurrence of advanced conduction delays, if left untreated, can be responsible for sudden cardiac death after discharge.ObjectiveWe aimed to determine the electrocardiographic predictors of advanced conduction disturbance that required a permanent pacemaker implantation (PPM) after TAVR.MethodsAll consecutive patients who underwent TAVR between January 2016 to July 2019 were identified from by a retrospective review of TAVR database at this centre.ResultsA total of 77 patients underwent TAVR within the study period and 7 patients were excluded as they had a pre-existing pacemaker/implanted cardiac defibrillator and 2 patients were excluded due to insufficient data. 36 of the patients were males (52%) with an average age of 82.1 years. The average BMI was 26.8 and 62 patients (91.1%) were symptomatic with New York Heart Association class 3 or above.All 68 patients had self-expanding Medtronic CoreValveTM. 10 (14.7%) patients required a PPM within an average of 5.3 days for an indication of either complete heart block or intermittent complete heart block. Of the 10 patients who had a PPM inserted,3 patients had a Right Bundle Branch Block (RBBB) at baseline. These patients were all pacing-dependent (>80% pacing when lower rate was programmed at 60 beats/min) at 6 weeks post-implantation follow-up. 4 out of 7 patients (57%) who had a non-RBBB pattern (i.e. LBBB or normal QRS complex) at baseline had an average pacing requirement of <2% at 6 weeks post implant follow-up. In the non-PPM group, 3 patients had a RBBB pattern and 15 had a LBBB pattern at baseline. Patients who had a baseline RBBB were more likely to require a PPM post TAVI (p-value = 0.02).ConclusionBaseline RBBB ECG pre-TAVR is a significant predictor of delayed advanced AV block. Our study validates previous suggestions that patients with baseline RBBB should not be considered for early discharge and may require prolonged monitoring to detect delayed AV conduction abnormalities. These patients are less likely to recover from their conduction disturbances as suggested by their pacing requirement at 6 week post-implantation follow-up.

• Publisher: BMJ Publishing Group LTD
• Subject: Pacemakers