Pre-existent 1st degree AV-Block before TAVI with Sapien 3 – is prolonged monitoring required?

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

Download Full-text

Anatomical predictors of high grade atrioventricular conduction disorders in patients with specific pacemaker implanted after TAVI

EP Europace ◽

10.1093/europace/euab116.401 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

P Frey ◽

A Brochier ◽

N Nezzouhairi ◽

D Irles

Keyword(s):

Atrioventricular Block ◽

Pacemaker Implantation ◽

Atrioventricular Conduction ◽

High Grade ◽

Av Block ◽

Conduction Disorders ◽

Transcatheter Aortic Valve ◽

The Difference ◽

Valve Implantation ◽

Membranous Septum

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf STIM TAVI-MS study Background The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. Recent studies have identified short membranous septum (MS) length, deep implantation depth (ID) or their relation as anatomic risk of high-grade AV block and permanent pacemaker implantation. Purpose : We sought to examine whether the atrioventricular (AV) membranous septum (MS) measured by computed tomography (CT) and the depth of valve implantation measured from the final aortic angiogram could predict high-grade atrioventricular block (HG AVB) after TAVI, based on specific pacemaker memory data. Methods STIM-TAVI-MS was a prospective, multicentre observational study that enrolled patients implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of late (after Day 7) high-grade atrioventricular block(s) during the year after TAVI. We measured on CT scans the coronal MS lenght, infra-annular MS lenght and the quantification of calcifications, on the final angiogram after TAVI we measured the implant depth (ID) to identifie ΔID-MS corresponding to the difference between implant depth and MS length. The variables were compared with the occurrence of late HG-AVB on PM memory data. Results : Among 82 patients, (mean age 84,5 years ± 4,8, self-expending valve n = 24, 29,3%), n = 47 (57.3%) had ≥1 late high-grade atrioventricular block. Mean coronal MS length was 8,1 ± 2,5 mm, mean infra annular MS was 3,4 ± 3.1 mm, mean calcification volume was 93.0 ± 88, 85,5± 104 and 141,5 ± 137,5 mm3 for the noncoronary, right coronary and left coronary cusp respectively. Mean implant depth was 7,3 ± 3,3mm, and mean ΔID-MS = -0,7 ± 4,1mm. There were no association between MS length (OR = 1,06; CI 0,91 to 1,24), ID (OR = 1,6; CI 0,85 to 2,9), nor ΔID-MS (OR = 0,67; CI 0,37 to 1,23) and late HG AVB. Calcification volume were not associated with late HG AVB. Conclusion In an high risk high grade AV block population after TAVI, anatomical analysis of MS length, degree of calcification, implant depth and ΔID-MS did not predict occurrence of late (> day 7 after TAVI ) high grade AV Blocks. Abstract Figure. CT scan A : aortic plane, B : MS lenght

Download Full-text

High-grade Atrioventricular Block in Pilot

Indonesian Journal of Cardiology ◽

10.30701/ijc.950 ◽

2020 ◽

Author(s):

Stephanie Salim ◽

Sunu Budhi Raharjo ◽

Dony Yugo Hermanto ◽

Dicky Armein Hanafy ◽

Yoga Yuniadi

Keyword(s):

Pacemaker Implantation ◽

Holter Monitoring ◽

Coronary Intervention ◽

Atrial Pacing ◽

High Grade ◽

Av Block ◽

Av Node ◽

Flight Operations ◽

Threatening Condition ◽

History Of

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Download Full-text

Long-term management of high-grade atrioventricular block using cilostazol in a cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116919878913 ◽

2019 ◽

Vol 5 (2) ◽

pp. 205511691987891

Author(s):

Naoki Iwasa ◽

Naohito Nishii ◽

Satoshi Takashima ◽

Yui Kobatake ◽

Saki Nomura ◽

...

Keyword(s):

Histopathological Examination ◽

Pacemaker Implantation ◽

Clinical Signs ◽

Conduction System ◽

High Grade ◽

Av Block ◽

Histological Findings ◽

Case Summary ◽

Term Management

Case summary A 12-year-old neutered female domestic shorthair cat was admitted for syncope. Clinical signs and electrocardiography revealed high-grade atrioventricular (AV) block. Treatment with cilostazol ameliorated the clinical signs and arrhythmia. However, the high-grade AV block recurred on several occasions. After 640 days, the cat presented again with clinical deterioration owing to reoccurrence of the arrhythmia and it died 11 days later. Histopathological examination revealed a loss of conduction cells within the His bundle. Relevance and novel information To our knowledge, this is the first report of high-grade AV block treated with cilostazol in a cat. Treatment with cilostazol prolonged survival for 650 days without pacemaker implantation. Histological findings suggested that the AV block was related to fibrosis of the impulse conduction system.

Download Full-text

Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

Case Reports in Cardiology ◽

10.1155/2016/1971803 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Rhanderson Cardoso ◽

Carlos E. Alfonso ◽

James O. Coffey

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Literature Review ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

High Grade ◽

Av Block ◽

Permanent Pacemaker Implantation ◽

Acute Mi ◽

Artery Disease

Complete atrioventricular (AV) block is known to be reversible in some cases of acute inferior wall myocardial infarction (MI). The reversibility of high-grade AV block in non-MI coronary artery disease (CAD), however, is rarely described in the literature. Herein we perform a literature review to assess what is known about the reversibility of high-grade AV block after right coronary artery revascularization in CAD patients who present without an acute MI. To illustrate this phenomenon we describe a case of 2 : 1 AV block associated with unstable angina, in which revascularization resulted in immediate and durable restoration of 1 : 1 AV conduction, thereby obviating the need for permanent pacemaker implantation. The literature review suggests two possible explanations: a vagally mediated response or a mechanism dependent on conduction system ischemia. Due to the limited understanding of AV block reversibility following revascularization in non-acute MI presentations, it remains difficult to reliably predict which patients presenting with high-grade AV block in the absence of MI may have the potential to avoid permanent pacemaker implantation via coronary revascularization. We thus offer this review as a potential starting point for the approach to such patients.

Download Full-text

High-grade Atrioventricular Block in Pilot

Indonesian Journal of Cardiology ◽

10.30701/ijc.v1i1.950 ◽

2020 ◽

Author(s):

Stephanie Salim ◽

Sunu Budhi Raharjo ◽

Dony Yugo Hermanto ◽

Dicky Armein Hanafy ◽

Yoga Yuniadi

Keyword(s):

Pacemaker Implantation ◽

Holter Monitoring ◽

Coronary Intervention ◽

Atrial Pacing ◽

High Grade ◽

Av Block ◽

Av Node ◽

Flight Operations ◽

Threatening Condition ◽

History Of

Download Full-text

Clinically Significant High-Grade AV Block as a Reversible Cause for Acute Kidney Injury in Hospitalized Patients—A Propensity Score Matched Cohort

Journal of Clinical Medicine ◽

10.3390/jcm10112424 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2424

Author(s):

Aviram Hochstadt ◽

Ido Avivi ◽

Merav Ingbir ◽

Yacov Shacham ◽

Ilan Merdler ◽

...

Keyword(s):

Acute Kidney Injury ◽

Propensity Score ◽

Clinical Decision Making ◽

Pacemaker Implantation ◽

Kidney Injury ◽

Clinical Decision ◽

Adverse Outcomes ◽

High Grade ◽

Av Block ◽

Threatening Condition

Background. High-grade AV block (HGAVB) is a life-threatening condition. Acute kidney injury (AKI) which is usually caused by renal hypo-perfusion is associated with adverse outcomes. We aimed to investigate the association between AKI and HGAVB. Methods. This is a retrospective cohort comparing the incidence of AKI among patients with HGAVB requiring pacemaker implantation compared with propensity score matched controls. Primary outcome was the incidence of AKI at admission. Secondary outcomes were change in creatinine levels, AKI during stay, recovery from AKI, mortality and major adverse kidney events (MAKE). Results. In total, 80 HGAVB patients were compared to 400 controls. HGAVB patients had a higher proportion of admission AKI compared to controls (36.2% versus 21.1%, RR = 1.71 [1.21–2.41], p = 0.004). Creatinine changes from baseline to admission and to maximum during hospitalization, were also higher in HGAVB (p = 0.042 and p = 0.033). Recovery from AKI was more frequent among HGAVB patients (55.2% vs. 25.9%, RR = 2.13 [1.31–3.47], p = 0.004) with hospitalization time, MAKE and crude mortality similar (p > 0.158). Conclusions. AKI occurs in about one third of patients admitted with HGAVB, more frequent compared to controls. Patients with AKI accompanying HGAVB were likelier to recover from AKI. Further studies to explore this relationship could aid in clinical decision making for HGAVB patients.

Download Full-text