0304: How long should we keep a temporary pace maker after transcatheter aortic valve replacement (TAVR)

Abstract

A temporary pace-maker (TPM) is often used after TAVR due to the risk of atrioventricular block (AVB) in the following days, related to progressive conduction system injuries. However guidelines are unclear as when to safely remove it. Between 2013 and 2014, 195 patients without previous permanent pacemaker, were prospectively followed after TAVR (69 Edwards Sapiens (ES) and 126 CoreValve (CV)). 47 had preoperative bundle branch block, 23 left (LBBB), 24 right sided (RBBB). Peri-operative high degree AVB was noted in 37 patients (20%). 24 were transient, less than 10mn and; 13 persisted at the end of the procedure and were implanted with a permanent pace-maker. New LBBB was observed in 55 patients (28%). In the post-operative period, 23 patients (13%) developped AVB (20 patients within 5 days, and 3 patients after 7 days) (4 ES and 19 CV). No new AV block had occurred at one month in the remaining population. Risk factors for late AVB were peri-operative transient AVB (40%), post-operative RBBB (30%), or LBBB (20%); preexistent RBBB and Corevalve model. Conversely 41 of the 42 patients without AVB or bundle branch block did not need temporary pacing in the post operative time. The only patient without any perioperative event who developed a late AV block at day 7 had a CV inserted in an old surgical valve. However, sinus dysfunction occurred in 2 patients treated with amiodarone for atrial fibrillation in the post operative period, needing temporary pacing. Conclusion: The use of TPM after TAVR is common for the management of delayed high degree AVB. The main risk factors are peri-operative AVB and post-operative BBB. Most of delayed AVB occur within 5 days. Later AVB preceded by prolonged PR interval and BBB should increase the length of TPM. However, in the absence of these factors TPM could be shortened. Abstract 0304 – Figure: Time occurence of AVB (CV=Corevalve, ES=Sapien)