Temporal Incidence and Predictors of High-Grade Atrioventricular Block After Transcatheter Aortic Valve Replacement

• Published in: Journal of the American Heart Association 2021-05, Vol.10 (10), p.e020033-e020033
• Main Authors: El-Sabawi, Bassim, Welle, Garrett A, Cha, Yong-Mei, Espinosa, Raúl E, Gulati, Rajiv, Sandhu, Gurpreet S, Greason, Kevin L, Crestanello, Juan A, Friedman, Paul A, Munger, Thomas M, Rihal, Charanjit S, Eleid, Mackram F
• Format: Article
• Language: English
• Subjects: bradycardia; bundle‐branch block; Original Research; pacemaker; sudden cardiac death; transcatheter aortic valve implantation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.020033

Background The temporal incidence of high-grade atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) is uncertain. As a result, periprocedural monitoring and pacing strategies remain controversial. This study aimed to describe the temporal incidence of initial episode of HAVB stratified by pre- and post-TAVR conduction and identify predictors of delayed events. Methods and Results Consecutive patients undergoing TAVR at a single center between February 2012 and June 2019 were retrospectively assessed for HAVB within 30 days. Patients with prior aortic valve replacement, permanent pacemaker (PPM), or conversion to surgical replacement were excluded. Multivariable logistic regression was performed to assess predictors of delayed HAVB (initial event >24 hours post-TAVR). A total of 953 patients were included in this study. HAVB occurred in 153 (16.1%). After exclusion of those with prophylactic PPM placed post-TAVR, the incidence of delayed HAVB was 33/882 (3.7%). Variables independently associated with delayed HAVB included baseline first-degree atrioventricular block or right bundle-branch block, self-expanding valve, and new left bundle-branch block. Forty patients had intraprocedural transient HAVB, including 16 who developed HAVB recurrence and 6 who had PPM implantation without recurrence. PPM was placed for HAVB in 130 (13.6%) (self-expanding valve, 23.7% versus balloon-expandable valve, 11.9%;