Predictors of Conduction Disturbances Requiring a Late Permanent Pacemaker

This analysis shows that baseline right bundle branch block and increased PR length after transcatheter aortic valve replacement (TAVR) are independent predictors of advanced conduction disturbances requiring late pacemaker implantation. A simple electrocardiography can detect these potentially fatal conduction disturbances that might happen more than 48 hours after TAVR.

Data from consecutive TAVR patients from one center (Milan, Italy) were gathered between 2007 and 2015. Delta PR and delta QRS were defined as the difference between the last PR and QRS length available 48 hrs. after TAVR and baseline PR and QRS length.

The study looked at data from 740 patients, excluding 78 that already had a pacemaker and 51 that had received one less than 48 hrs. after TAVR, which left 611 patients for final analysis.

8.8% developed conduction disturbances requiring a pacemaker ≥48h after procedure. Patients requiring late pacemaker implantation had wider QRS (113 ± 25 ms vs. 105 ± 23 ms; p=0.009), higher prevalence of right bundle branch block (12.9% vs. 5.3%; p=0.026) and were more likely to receive a self-expandable valve (51.8% vs. 31.9%; p=0.003).

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Delta PR was 40 ± 51 ms (p=0.0001) and delta QRS was 22 ± 61 ms (p=0.001).

Multivariable analysis showed that baseline right bundle branch block had between 3.5 and 4 times higher risk of getting a pacemaker (p=0.0001) and delta PR increased this risk by 1.3 times every 10 ms (p=0.0001).

Conclusion

The evidence consolidates in favor of a simple ECG to detect patients at higher risk of requiring late pacemaker implantation after TAVR. Baseline bundle branch block and increased PR are predictors of late advanced conduction disturbances.

Original title: Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 hs) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement.

Reference: Antonio Mangieri et al. J Am Coll Cardiol Intv 2018;11:1519–26.

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