Author + information
- Received January 11, 2018
- Revision received June 8, 2018
- Accepted June 12, 2018
- Published online August 6, 2018.
- Antonio Mangieri, MDa,
- Giuseppe Lanzillo, MDa,
- Letizia Bertoldi, MDa,
- Richard J. Jabbour, MDb,
- Damiano Regazzoli, MDa,
- Marco B. Ancona, MDa,
- Akihito Tanaka, MDa,
- Satoru Mitomo, MDa,
- Stefano Garducci, MDc,
- Claudio Montalto, MDa,
- Matteo Pagnesi, MDa,
- Francesco Giannini, MDa,
- Manuela Giglio, MDd,
- Matteo Montorfano, MDa,
- Alaide Chieffo, MDa,
- Josep Rodès-Cabau, MDe,
- Fabrizio Monaco, MDa,
- Gabriele Paglino, MDa,
- Paolo Della Bella, MDa,
- Antonio Colombo, MDa and
- Azeem Latib, MDa,f,∗ ()
- aIRCCS San Raffaele Scientific Institute, Milan, Italy
- bImperial College, London, United Kingdom
- cAzienda Socio-Sanitaria Territoriale, Vimercate, Italy
- dIstituto Clinico Sant’Ambrogio, Milan, Italy
- eQuebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- fDivision of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- ↵∗Address for correspondence:
Dr. Azeem Latib, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Objectives This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR).
Methods Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length.
Results Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 h after TAVR. The final analysis included 611 patients. Fifty-four patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 h following TAVR. Patients who required a late PPM implant had a wider QRS width (113 ± 25 ms vs. 105 ± 23 ms; p = 0.009) and a higher prevalence of baseline right bundle branch block (12.9% vs. 5.3%; p = 0.026) and were more likely to have a self-expandable valve implanted (51.8% vs. 31.9%; p = 0.003). The ΔPR was 40 ± 51 ms (p = 0.0001) and the ΔQRS was 22 ± 61 ms (p = 0.001). Multivariable analysis revealed that baseline right bundle branch block (odds ratio: 3.56; 95% confidence interval: 1.07 to 11.77; p = 0.037) and ΔPR (odds ratio for each 10-ms increase: 1.31; 95% confidence interval: 1.18 to 1.45; p = 0.0001) are independent predictors of delayed advanced conduction disturbances.
Conclusions This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR.
- aortic stenosis
- left bundle branch block
- permanent pacemaker
- right bundle branch block
- transcatheter aortic valve replacement
Dr. Rodès-Cabau has received institutional research grants from Edwards Lifesciences and Medtronic. Dr. Latib is on the Medtronic Advisory Board; and has received speaking honoraria from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 11, 2018.
- Revision received June 8, 2018.
- Accepted June 12, 2018.
- 2018 American College of Cardiology Foundation
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