Impact of conductive disturbances on length of stay after TAVI: A single-centre retrospective study

Abstract

Conductive disturbances remain the most frequent complication after TAVI. Management of conduction disturbances is highly variable among centres and impact length of stay (LOS). Recently, an expert consensus has been proposed in order to reduce their impact on LOS. To evaluate the impact of the expert consensus for the management of conductive disturbances to reduce LOS after TAVI. We retrospectively included patients who underwent a TAVI between January 1st, 2017 and December 31st, 2018. Patients who had a pacemaker before TAVI were excluded. ECG before, immediately after and the first two days after TAVI were analysed. According to the expert consensus, patients were classified in 5 groups: group 1 (normal ECG and no modification after TAVI), group 2 (pre-implantation right bundle branch block without modification after TAVI), group 3 (PR or QRS enlargement > 20 ms in patients with pre-existing conductive disturbances), group 4 (new onset left bundle blanch block), group 5 (High degree atrioventricular block or complete heart block during procedure). We assessed the proportion of patients early discharged (within 72 hours) among these 5 groups. During the studied period, 348 patients were included. The median LOS was 2 [2–4] days and 245 (71%) patients were discharged early. LOS were longer in groups 2, 3, 4 and 5. Patients in groups 3, 4 and 5 were discharged early in 62%, 65%, and 63% of cases respectively. In contrast, group 1 patients were discharged early in 77% of cases. Patients identified as having a high risk of delayed conductive disturbances by the consensus had longer LOS (5 [2.5–6.5] days with a lower rate of early discharge (39%) ( Table 1 ). This study confirm the impact of conductive disturbances on LOS. The consensus reduces their impact on LOS and allows early discharge in 71% of cases without other complications.