Author + information
- Received October 24, 2019
- Revision received January 7, 2020
- Accepted January 14, 2020
- Published online May 4, 2020.
- Amar Krishnaswamy, MDa,∗ (, )
- Yasser Sammour, MDa,
- Antonio Mangieri, MDb,
- Amer Kadri, MDa,
- Antonette Karrthik, MDa,
- Kinjal Banerjee, MDa,
- Manpreet Kaur, MDa,
- Francesco Giannini, MDb,
- Beniamino Pagliaro, MDc,
- Marco Ancona, MDc,
- Matteo Pagnesi, MDc,
- Alessandra Laricchia, MDb,
- Giora Weisz, MDd,
- Megan Lydena,
- Najdat Bazarbashi, MDa,
- Mohamed Gad, MDa,
- Keerat Ahuja, MDa,
- Stephanie Mick, MDe,
- Lars Svensson, MD, PhDe,
- Rishi Puri, MBBS, PhDa,
- Grant Reed, MD, MPHa,
- John Rickard, MDf,
- Antonio Colombo, MDb,
- Samir Kapadia, MDa and
- Azeem Latib, MDd
- aSection of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- bInterventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
- cUnit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- dDepartment of Cardiology, Montefiore Medical Center, New York, New York
- eDepartment of Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- fSection of Cardiac Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Amar Krishnaswamy, Cleveland Clinic, Department of Cardiovascular Medicine, 9500 Euclid Avenue, Desk J2-3, Cleveland, Ohio 44195.
Objectives The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI).
Background Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI.
Methods Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI.
Results A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%).
Conclusions Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.
- atrial pacing
- electrophysiology study
- permanent pacemaker implantation
- transcatheter aortic valve replacement
Dr. Latib is an advisory board member for Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received October 24, 2019.
- Revision received January 7, 2020.
- Accepted January 14, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.