Abstract
Introduction
Pre-existing right bundle branch block (RBBB) is a well stablished risk factor for the development of high grade conduction abnormalities (CAs) after TAVI. The association of pre-existing 1st degree AV-Block (AVB1) with high grade CAs after TAVI has been inconsistent. A recently published Expert Consensus Document classifies patients with AVB1 in the lowest risk group, allowing for discharge at day 1 post-TAVI. We aimed to study the risk of these patients of developing delayed high grade CAs requiring pacemaker implantation (PM).
Methods
We studied the development CAs in 1447 consecutive patients treated with Sapien 3 between January 2014 and December 2019. After excluding valve-in-valve procedures (n=30) and pts with previously implanted PM (n=167) 1254 patients remained for analysis. All patients were monitored for at least 7 days, as this was our institutional policy during the study period. We analyzed if pre-existing ECG abnormalities predict early and delayed (>24h) high grade CAs with a multivariable logistic regression model.
Results
Of 1254 pts, 159 (12.5%) required a permanent PM after TAVI. In 104 (65%) CAs requiring PM occurred intraprocedural or during the first 48h while in the remaining 35% developed with more delay. We analyzed the presence of previous CAs in pts still free from indication for PM after the first 48h after TAVI (n=1150) in order to identify characteristics that may predict delayed PM requirement (Table). In the multivariable model not only RBBB (OR 5.42, CI95% 2.69–10.94, p<0.0001) but also AVB1 was significantly associated to delayed high grade CAs requiring PM implantation (OR 2.25, CI95% 1.24–4.08, p=0.005).
Conclusion
In this study, in pts requiring PM implantation after TAVI, the high grade CAs occurred after 48h in 35% of patients. Not only RBBB but also AVB1 was an independent predictor of delayed high grade CAs. These results question the safety of considering patients with pre-existing AVB1 as low-risk patients and suggest a more prolonged monitoring also for them.
Funding Acknowledgement
Type of funding source: None
Expert’s Opinion–Challenging ECG