PO-05-022 OUTCOMES FOR POST-TRANSCATHETER AORTIC VALVE REPLACEMENT CONDUCTION ABNORMALITIES WITHOUT CLEAR INDICATION FOR PERMANENT PACING

Abstract

Patients undergoing transcatheter aortic valve replacement (TAVR) often develop conduction abnormalities in the postprocedural period. While high-grade AV block (HAVB), which includes 3rd degree & 2nd degree type 2 Mobitz AV block, is a clear indication for permanent pacemaker (PPM) implantation, other conduction abnormalities do not have a clear indication for PPM. Outcomes and predictors for subsequent PPM in this population is lacking. To investigate outcomes of non-HAVB conduction abnormalities in the immediate post-TAVR setting. We conducted a single-center retrospective study on patient characteristics and outcomes of patients without PPM who underwent TAVR between June 2020 and March 2022 that developed non-HAVB conduction abnormalities without a clear indication for pacing (Table 1A). All these patients received thirty-day ambulatory event monitoring (AEM) at discharge. A total of a hundred and sixty patients underwent TAVR; thirteen patients outright received a new PPM for HAVB while thirty-six patients developed non-HAVB and were discharged with AEM. Mean age was 79.8 ± 6.1 years, mean ejection fraction (EF) was 62.1 ± 9.1%, mean maximum aortic valve velocity was 3.9 ± 0.5 m/sec, average mean gradient across the valve was 36.8 ± 10.0 mmHg, and mean aortic valve area was 0.76 ± 0.18 cm2 for these patients. Among the patients who developed non-HAVB conduction abnormalities after TAVR, four subsequently required PPM implantation. Pre-existing right bundle branch block (RBBB) was more frequent in the group requiring eventual PPM vs. the group not requiring PPM (Table 1B). There were no statistically significant differences between several electrocardiogram metrics, demographics, and valve measurements, outlined in Table 1B. Details of those who received subsequent PPM can be found in Table 1C. Of patients who developed persistent non-HAVB conduction abnormalities in the immediate post-TAVR setting the incidence of pre-existing RBBB was higher in patients who required eventual permanent pacing versus those who did not require eventual permanent pacing.