0052 : Electrocardiography and electrophysiology studies before and after transcatheter aortic valve replacement as tools to decide permanent pacemaker implantation and patient's monitoring

Abstract

Cardiac conduction disturbances frequently occurred after transcatheter aortic valve replacement (TAVR), leading to permanent pacemaker (PPM) implantation. The aim is to identify predictive factors of early and late high degree atrioventricular blocks (AVB). free patients who underwent TAVR from January 2013 to December 2014 were included. His bundle recording (HBR) was performed before TAVR (HV1), immediately after (HV2) and at day 2 for Sapiens valve or day 5 for Medtronic CoreValve (HV3). PPM was implanted if AVB occurred or HV3 > 80ms. 84 patients (age 83±9 [mean±SD], Female 59%, Medtroncic Core- Valve 67%) were included. 28 PPM (33%) were implanted for documented AVB (n=17), prolonged HV interval (n=9) or sick sinus syndrome (n=2). High degree AVB after discharge was observed in 13 patients (17.8%). The mean of HV1, HV2 and HV3 were 56ms±10, 71ms ±20 and 63ms ±14, respectively. There was no correlation between HV1, HV2 or HV3 with AVB. Preoperative right bundle branch block (RBBB) and AVB during TAVR were associated with early AVB (respectively p=0.03, p=0.002), leading to prolonged monitoring (fig1). Early post-operative AVB was associated with late AVB (p<0.001). Repeated HBR did not provide any guidance for PPM implantation. RBBB and peroperative high degree AVB are risk factors for AVB after TAVR. Early post-operative AVB is a strong predictive factor of long term recurrence AVB and should be considered for the decision of PPM implantation. Figure algorithm of patient's monitoring before and after TAVR. AVB = atrioventricular block, D=day, TAVR = transcatheter aortic valve replacement The author hereby declares no conflict of interest