Evolution of high‐grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode—that minimizes ventricular pacing—activated. (4th March 2021)

• Record Type: Journal Article
• Authors: Irles, Didier; Salerno, Fiorella; Cassagneau, Romain; Eschalier, Romain; Maupain, Carole; Dupuis, Jean‐Marc; Mansourati, Jacques; Guedon, Laurence; Marijon, Eloi; Frey, Pierre
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 5(2021)
• Page Start: 1376
• Page End: 1384
• Publication Date: 2021-03-04
• Subjects: evolution -- high‐grade atrioventricular block -- outcomes -- pacemaker -- transcatheter aortic valve implantation; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14970
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high‐grade atrioventricular blocks after TAVI, based on specific pacemaker memory data. Methods and Results: STIM‐TAVI (NCT03338582) was a prospective, multicentre, observational study that enrolled all patients (from November 2015 to January 2017) implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of centrally adjudicated late high‐grade atrioventricular blocks during the year after TAVI. Among 197 patients, 138 (70.1%) had ≥1 late high‐grade atrioventricular block. Whereas oversizing ( p = .005), high‐grade atrioventricular block during TAVI ( p < .001), and early (within 6 days) high‐grade atrioventricular block ( p < .001) were associated with occurrence of late high‐grade atrioventricular block, self‐expanding prothesis ( p = .88), prior right bundle branch block ( p = .45), low implantation ( p = .06), and new or wider left bundle branch block and lengthening of PR interval ( p = .24) were not. In multivariable analysis, only post‐TAVI early high‐grade atrioventricular block remained associated with late high‐grade atrioventricular blocks (Days 0–1: odds ratio [OR], 3.25; 95% confidence interval [CI], 1.57–6.74; p = .001; Days 2–6: OR, 4.13; 95% CI, 2.06–8.31; p < .001), whereas other conventionally used predictors were not. Conclusion: One‐third of pacemaker‐implanted patients do not experience late high‐grade atrioventricular block. Our findings suggest that post‐TAVI early high‐grade atrioventricular block is the main factor associated with occurrence of late high‐grade atrioventricular blocks.