Delayed Total Atrioventricular Block After Transcatheter Aortic Valve Replacement Assessed by Implantable Loop Recorders

Reiter, Christian; Lambert, Thomas; Kellermair, Joerg; Blessberger, Hermann; Fellner, Alexander; Nahler, Alexander; Grund, Michael; Steinwender, Clemens

doi:10.1016/j.jcin.2021.09.003

Cited by 21 publications

(13 citation statements)

References 28 publications

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“… 8 Similarly, two recent studies showed that PR duration predicted delayed AVB. 21 , 22 However, in our study, although first-degree AVB was more common in the PM group, it was not a risk factor for PM after TAVI and nor was PR duration. This may be attributed to our study involving patients referred to TAVI earlier, with lower disease severity and comorbidity compared with early phases of TAVI.…”

Section: Discussioncontrasting

confidence: 62%

Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study

Kaya,

Andresen,

Lie

et al. 2023

European Heart Journal - Cardiovascular Imaging

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Aims Permanent pacemaker (PM) implantation is common after TAVI. Left ventricular mechanical dispersion (MeDi) by speckle tracking echocardiography is a marker of fibrosis that causes alterations in the conduction system. We hypothesized that MeDi can be a predictor of need for PM implantation after TAVI. Methods and Results Consecutively, 200 TAVI patients were enrolled. Transthoracic echocardiography and electrocardiography examinations were recorded before TAVI to evaluate global longitudinal strain (GLS), MeDi and conduction disturbances. PM implantation information was obtained three months after TAVI. Patients were stratified into PM- or no-PM group. Mean age was 80 ± 7 years (44% women). Twenty-nine patients (16%) received PM. MeDi, QRS duration, existence of right bundle branch block (RBBB) and first-degree AV block were significantly different between groups. MeDi were 57 ± 15 ms and 48 ± 12 ms in PM and no-PM groups, respectively (p < 0.001). In multivariate analysis, MeDi predicted the need for PM after TAVI independently of GLS, QRS duration, RBBB and first-degree AV block (OR: 1.73, 95% CI: 1.22-2.45) with an AUC of 0.68 in ROC curves. Moreover, RBBB was an independent predictor of PM need after TAVI (OR: 8.98, 95% CI: 1.78-45.03). When added to RBBB, MeDi had an incremental predictive value with an AUC of 0.73 in ROC curves (p = 0.01). Conclusion MeDi may be used as an echocardiographic functional predictor of need for PM after TAVI.

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Section: Discussioncontrasting

confidence: 62%

Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study

Kaya,

Andresen,

Lie

et al. 2023

European Heart Journal - Cardiovascular Imaging

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“…It was also suggested in some studies that ΔPR (the difference between the postoperative and preoperative PR intervals) was probably an independent predictor of delayed late conduction disorders (≥48 h) after TAVR ( 53 ), with ΔPR > 40 ms linked notably to an increased risk of PPI ( 54 ). In particular, a study on delayed total atrioventricular block (DT-AVB) morbidity and potential predictors after TAVR highlighted that intraoperative HV interval prolongation (OR: 1.07; 95% CI: 1.02–1.14; p = 0.015) and PQ interval prolongation between the next day post-TAVR and baseline (OR: 1.04; 95% CI: 1.01–1.09; p = 0.032) might predict the occurrence of DT-AVB ( 55 ). Recently, Yagel et al reported that the R-wave amplitude in the V1 lead of the baseline ECG appeared to predict the onset of HAVB in patients with new-onset LBBB post-TAVR, and patients with HAVB requiring PPI had a significantly lower baseline R-wave amplitude in the V1 lead than those who did not develop HAVB (0.029 ± 0.04 mV vs. 0.11 ± 0.14 mV, p = 0.0316) ( 56 ).…”

Section: Predictors Of Conduction Abnormalities After Tavrmentioning

confidence: 99%

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

Yu,

Fu,

Xia

et al. 2024

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) has increasingly become a safe, feasible, and widely accepted alternative surgical treatment for patients with severe symptomatic aortic stenosis. However, the incidence of conduction abnormalities associated with TAVR, including left bundle branch block (LBBB) and high-degree atrioventricular block (HAVB), remains high and is often correlated with risk factors such as the severity of valvular calcification, preexisting conditions in patients, and procedural factors. The existing research results on the impact of post-TAVR conduction abnormalities and permanent pacemaker (PPM) requirements on prognosis, including all-cause mortality and rehospitalization, remain contradictory, with varied management strategies for post-TAVR conduction system diseases across different institutions. This review integrates the latest research in the field, offering a comprehensive discussion of the mechanisms, risk factors, consequences, and management of post-TAVR conduction abnormalities. This study provides insights into optimizing patient prognosis and explores the potential of novel strategies, such as conduction system pacing, to minimize the risk of adverse clinical outcomes.

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“…In this cohort the incidence of HAVB was around 12%, and these patients were diagnosed between 2 days and 3 months post TAVR. The prolongation of the PQ (OR: 1.04, 95% CI: 1.01–1.09, p : 0.032) and the HV (OR: 1.07, 95% CI: 1.02–1.14, p : 0.015) intervals were found to be predictors of delayed HAVB [ 33 ]. For the seven patients with delayed HAVB, they underwent PPM implantation with a mean pacing rate of 21.2% (0.5–63.0%) at the 3-month follow up point.…”

Section: Prevention and Detection Of Conduction System Disease After ...mentioning

confidence: 99%

Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement

Alabdaljabar

Eleid

2023

JCM

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Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS and the severity of valve calcification, patients’ pre-existing conditions (i.e., conduction disease, anatomical variations, and short septum) in addition to procedure-related factors (e.g., self-expanding valves, implantation depth, valve-to-annulus ratio, and procedure technique). Detailed evaluation of risk profiles could allow us to better prevent, recognize, and treat this entity. Available evidence on management of conduction disease post TAVR is based on expert opinion and varies widely. Currently, conduction disease in TAVR patients is managed depending on patient risk, with minimal-to-no inpatient/outpatient observation, inpatient monitoring (24–48 h) followed by ambulatory monitoring, or either prolonged inpatient and outpatient monitoring or permanent pacemaker implantation. Herein, we review the incidence and risk factors of TAVR-associated conduction disease and discuss its management.

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Delayed Total Atrioventricular Block After Transcatheter Aortic Valve Replacement Assessed by Implantable Loop Recorders

Cited by 21 publications

References 28 publications

Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study

Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement

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