PO-03-110 NEW INSIGHTS FROM HIS VENTRICULAR INTERVALS IN PATIENTS UNDERGOING TAVR AND IMPLICATIONS FOR PERMANENT PACING

Abstract

Trans catheter aortic valve replacement (TAVR) represents a revolutionary treatment for patients with severe symptomatic aortic stenosis who are at high surgical risk. The rate of periprocedural complications has decreased over time. However, the incidence of conduction disease requiring permanent pacemaker (PPM) implantation has failed to decrease. The decision for PPM for conduction disease post TAVR is usually made based on ECG. It’s not uncommon for patients with conduction disease without evidence for infra-nodal block to receive a PPM, and pacing has been shown to have deleterious effects. To assess the utility of His Ventricular Interval (HVI) studies in predicting the need for PPM implantation. We included patients who underwent assessment of the AV nodal (AH interval) and the HVI pre and/or post TAVR and were continuously monitored until discharge and after discharge for 2 weeks. Repeat EP study was performed in the presence of new conduction disease during in-hospital or as an outpatient. PPM was recommended in the presence of complete heart block (CHB), infra-Hisian block or with an HV > 70 ms (discretion of the physician). Patients receiving PPM before 30 days were documented. Total of 71 patients who had pre and post TAVR EP study had follow up for at least 30 days. The Cohort predominantly male with an average age of 77 years. Forty-six patients received Edwards and 25 Medtronic valve. A total of 6 patients received PPM, 5 out of 6 within the index hospitalization, and 1 patient 5 days post discharge. Four out of 6 patients with PPM had Edwards and 2 out of 6 had Medtronic valve. Four out of 6 patient who received PPM, developed CHB during TAVR and HVI post TAVR was not measured; in 1 patient HVI could not be measured reliably because of atrial fibrillation and the other had normal pre and post HVI. Ten of 71 patients had pre-existing Bundle Branch Block (BBB). Four had right bundle branch block (RBBB) of which 1 required PPM, and 6 had left bundle branch block (LBBB) of which 1 required PPM. Six of 71 patients had new BBB post TAVR. 5 developed LBBB of which 2 required PPM, and 1 developed RBBB of which none required PPM In patients undergoing TAVR, pre and post TAVR EP study is very useful in determining the need for PPM. In the absence of significant infra-Hisian disease, Pre-TAVR RBBB or LBBB and new RBBB or LBBB are not an indication for PPM.Tabled 1HVI in pre-existing (Old)and post TAVR (new) Bundle Branch block (PO-03-110)Pre-existing LBBBPre-existing RBBBPost-TAVR (new) LBBBPost-TAVR (new) RBBBPatientPre-HVI (ms)Post-HVI (ms)PPM (yes/no)PatientPre-HVI (ms)Post-HVI (ms)PPM (yes/no)PatientPre-HVI (ms)Post-HVI (ms)PPM (yes/no)PatientPre-HVI (ms)Post-HVI (ms)PPM (yes/no)16063no155CHByes15255no14043no25060no25053no24871no35558yes35055no35058yes44548no44045no46063no55560no54859yes66373no Open table in a new tab