Author + information
- Received December 9, 2015
- Revision received March 14, 2016
- Accepted March 22, 2016
- Published online June 27, 2016.
- Stefan Toggweiler, MDa,∗ (, )
- Stefan Stortecky, MDb,
- Erik Holy, MDc,
- Katarzyna Zuk, MDb,
- Florim Cuculi, MDa,
- Fabian Nietlispach, MDc,
- Zaid Sabti, MDa,
- Raluca Suciu, MDc,
- Willibald Maier, MDc,
- Peiman Jamshidi, MDa,
- Francesco Maisano, MDc,
- Stephan Windecker, MDb,
- Richard Kobza, MDa,
- Peter Wenaweser, MDb,
- Thomas F. Lüscher, MDc and
- Ronald K. Binder, MDc
- aHeart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- bSwiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
- cHeart Center, University Hospital Zurich, Zurich, Switzerland
- ↵∗Reprint requests and correspondence:
Dr. Stefan Toggweiler, Heart Center Lucerne, Cardiology, Spitalstrasse, 6000 Luzern, Switzerland.
Objectives The study sought to identify predictors for delayed high-degree atrioventricular block (AVB) in patients undergoing transcatheter aortic valve replacement (TAVR) and determine the need and required duration of telemetry monitoring.
Background Little is known about predictors and timing of high-degree AVB.
Methods A total of 1,064 patients (52% women) without a permanent pacemaker undergoing TAVR at 3 centers in Switzerland were investigated. Electrocardiograms (ECGs) at baseline and post-TAVR were analyzed to identify atrioventricular and interventricular conduction disorders.
Results Periprocedural high-degree AVB occurred in 92 (8.7%), delayed high-degree AVB in 71 (6.7%), up to 8 days post-procedure. In multivariate analysis, delayed high-degree AVB occurred more frequently in men (odds ratio: 2.4, 95% confidence interval: 1.3 to 4.5; p < 0.01), and in patients with conduction disorders post-TAVR (odds ratio: 10.8; 95% confidence interval: 4.6 to 25.5; p < 0.01). Patients in sinus rhythm without conduction disorders post-TAVR did not develop delayed high-degree AVB (0 of 250, 0%). Similarly, the risk in patients with atrial fibrillation but no other conduction disorders was very low (1 of 102, 1%). There was no patient developing delayed high-degree AVB who had a stable ECG for 2 days or more.
Conclusion Patients without conduction disorders post-TAVR did not develop delayed high-degree AVB. Such patients may not require telemetry monitoring. All other patients should be monitored until the ECG remains stable for at least 2 days. This algorithm should be validated in a separate patient population.
Dr. Toggweiler has served as a proctor to Symetis SA and has received speaker fees from Edwards Lifesciences, Medtronic, and Symetis SA. Dr. Nietlispach has served as a consultant to Edwards Lifesciences, St. Jude Medical, Medtronic, Biotronik, and Direct Flow Medical. Dr. Maisano has served as a consultant to Medtronic, St. Jude Medical, Abbott Vascular, and ValtechCardio; has received royalties from Edwards Lifesciences; and has received an institutional grant from DirectFlow. Dr. Windecker has received institutional grants from Abbott, Boston Scientific, Biotronik, Biosensors, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr. Kobza has received unrestricted grant support from Medtronic and Biotronik. Dr. Wenaweser has served as a consultant and proctor Medtronic, Edwards Lifesciences, and Boston Scientific; and has received institutional grant support from Medtronic. Dr. Lüscher has received grant support from Biotronik, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has received honoraria from Medtronic. Dr. Binder has received research grant support from Edwards Lifesciences; and has served as a proctor and received personal fees from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Toggweiler, Stortecky, and Holy contributed equally to this work.
- Received December 9, 2015.
- Revision received March 14, 2016.
- Accepted March 22, 2016.
- American College of Cardiology Foundation