Author + information
- Received February 16, 2018
- Revision received March 26, 2018
- Accepted April 10, 2018
- Published online August 6, 2018.
- Troels H. Jørgensen, MDa,∗ (, )
- Ole De Backer, MD, PhDa,
- Thomas A. Gerds, DrRerNatb,
- Gintautas Bieliauskas, MDa,
- Jesper H. Svendsen, MD, DMSca and
- Lars Søndergaard, MD, DMSca
- aDepartment of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- bSection of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Troels H. Jørgensen, Rigshospitalet, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Objectives The aim of this study was to use a 12-lead electrocardiogram obtained immediately post–transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR.
Background There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR.
Methods A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR.
Results Self-expandable, mechanical, or balloon-expandable heart valves were implanted in 328 (70%), 61 (13%), and 78 (17%) patients, respectively. For patients in sinus rhythm without right bundle branch block, late HD-CD developed in 0 of 70 patients (0%; 95% confidence interval [CI]: 0% to 5.1%) with PR interval <200 ms and QRS interval <120 ms and in 5 of 109 patients (4.6%; 95% CI: 1.5% to 10.4%; all with sufficient escape rhythm) with PR interval <240 ms and QRS interval <150 ms. Late HD-CD developed in 14 of 101 patients (13.9%; 95% CI: 7.8% to 22.2%; 6 with insufficient escape rhythm [5.9%; 95% CI: 2.2% to 12.5%]) with PR interval ≥240 ms or QRS interval ≥150 ms. Furthermore, late HD-CD developed in 3 of 49 patients (6.1%; 95% CI: 1.3% to 16.9%; all with sufficient escape rhythm) and in 3 of 30 patients (10.0%; 95% CI: 2.1% to 26.5%; 2 with insufficient escape rhythm [6.7%; 95% CI: 0.8% to 22.1%]) with atrial fibrillation and no right bundle branch block with QRS interval <140 and ≥140 ms, respectively.
Conclusions On the basis of immediate post-TAVR 12-lead electrocardiography, removing the temporary pacemaker immediately following TAVR is potentially safe in patients without right bundle branch block who are: 1) in sinus rhythm with PR interval <240 ms and QRS interval <150 ms; or 2) in atrial fibrillation with a QRS interval <140 ms.
Dr. Jørgensen has received a research grant from Edwards Lifesciences. Dr. Søndergaard has received consulting fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Symetis. Dr. Svendsen is on the advisory board with Medtronic; has received speaker fees from Medtronic and Biotronik; and an institutional research grant from Medtronic, Biotronik, and Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 16, 2018.
- Revision received March 26, 2018.
- Accepted April 10, 2018.
- 2018 American College of Cardiology Foundation
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