Sex-specific differences in infranodal conduction properties in patients undergoing transcatheter aortic valve replacement

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Electrophysiological (EP) testing has been proposed for risk stratification of patients with left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). A uniform cut-off of 70ms for the His-Ventricular (HV) interval has been proposed to trigger pacemaker implantation. However, sex-specific periprocedural data regarding infranodal conduction properties are lacking. Purpose We aimed to compare the HV interval in men and women undergoing TAVR. Methods We analyzed consecutive prospectively included patients undergoing TAVR between June 2020 and June 2021 at a tertiary referral center. EP testing was performed in all patients pre- and post-valve deployment and in the case of LBBB additionally for a third time the following day. Results 127 patients were included (81 ± 7 years, 46% female). Median HV interval pre-valve deployment was 43 [37-50] ms vs 46 [42-53] ms in women and men, respectively (p=0.016). Nine patients underwent peri-procedural pacemaker (PM) implantation for third-degree AV-block. The median HV interval post-valve deployment was 54 [42-59] ms in women and 56 [51-61] ms in men (p=0.038). The median HV interval the day following TAVR in patients with LBBB was 45 [41-49] ms in women and 50 [48-62] ms in men (p=0.048). An HV interval ≥ 55 ms and ≥70 ms was present the day following TAVR in seven patients (24%, two females) and three patients (10%, one female). (Figure) Conclusion Women have shorter HV intervals pre-and post-valve-deployment as well as the day following TAVR compared to men. Further studies evaluating sex-specific cut-offs for the HV interval are warranted.