Taking into account a simple 12-lead electrocardiography performed immediately after transcatheter aortic valve implantation (TAVI), removing the temporary pacemaker immediately is safe in patients without right bundle branch block who are in sinus rhythm with PR interval <240 ms and QRS interval <150 ms. In cases of atrial fibrillation, a QRS interval <140 ms also reassures the decision to remove the temporary pacemaker immediately.

Few risk factors predicting a high-degree block after TAVI have been identified. In consequence, many sites have protocols in place indicating that the temporary pacemaker should be retained for 24 or 48 hours after the procedure, which, in many cases, increases the length of hospital stay unnecessarily.

This single-center study included 467 consecutive patients, without pre-procedural pacemakers, who underwent TAVI.

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Self-expandable, mechanical, or balloon-expandable valves were used in 328 (70%), 61 (13%), and 78 (17%) patients, respectively.

For patients who finalized the procedure without right bundle branch block, in sinus rhythm with PR interval <200 ms and QRS interval <120 ms, the chance of developing high-degree block was 0 of 70 patients (0%). Alternatively, 5 of 109 patients (4.6%) with PR interval <240 ms and QRS interval <150 ms (all with sufficient escape rhythm) developed high-degree block.

High-degree block developed in 14 of 101 patients (13.9%), only half of whom presented acceptable escape rhythm with PR interval ≥240 ms and QRS interval ≥150 ms.

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Late high-degree block developed in 3 of 49 patients (6.1%), all with sufficient escape rhythm, and in 3 of 30 patients (10.0%), among whom only 2 had sufficient escape rhythm with atrial fibrillation, no right bundle branch block, and QRS interval <140 and ≥140 ms, respectively.

Conclusion

Based on a 12-lead electrocardiography, removing the temporary pacemaker immediately after TAVR is safe if there is no right bundle branch block and the patient is in sinus rhythm with PR interval <240 ms and QRS interval <150 ms or, in case of atrial fibrillation, if the QRS interval is <140 ms.

Original title: Immediate Post-Procedural 12-Lead Electrocardiography as Predictor of Late Conduction Defects After Transcatheter Aortic Valve Replacement.

Reference: Troels H. Jørgensen et al. J Am Coll Cardiol Intv 2018;11:1509-18.

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