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Updated: Mar 30, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Baseline HV-interval predicts complete AV-block secondary to transcatheter aortic valve implantation
Insights
The HV-interval can predict heart block after transcatheter aortic valve implantation (TAVI). A prolonged HV-interval identifies patients at higher risk for complete atrioventricular (AV) block, enabling personalized risk management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrioventricular (AV) block is a common complication following transcatheter aortic valve implantation (TAVI).
- Predictive markers for AV block post-TAVI are crucial for patient management.
- The prognostic value of the pre-procedural HV-interval in TAVI is not well-established.
Purpose of the Study:
- To evaluate the predictive value of the HV-interval for the development of AV block after TAVI.
- To assess the association between pre-procedural HV-interval duration and the incidence of complete AV block.
Main Methods:
- The HV-interval was measured in 25 elderly patients with severe aortic stenosis before and immediately after TAVI.
- Patients were monitored for the development of complete AV block requiring pacemaker implantation.
- Statistical analysis was performed to determine the correlation between HV-interval prolongation and AV block incidence.
Main Results:
- 32% of patients (8 out of 25) developed complete AV block post-TAVI.
- Patients who developed complete AV block had significantly prolonged pre-procedural HV-intervals (62.1 ms vs 49.2 ms, P=0.029).
- An HV-interval exceeding 54 ms was associated with a higher rate of complete AV block (75% sensitivity, 77.8% specificity, P=0.01).
Conclusions:
- The HV-interval is prolonged in a significant proportion of patients undergoing TAVI for aortic stenosis.
- Pre-procedural HV-interval prolongation is a valuable predictor of complete AV block following TAVI.
- Measuring the HV-interval during TAVI screening can help identify at-risk patients for tailored management strategies.
Purpose:
Development of AV-block is a frequent complication associated with transcatheter aortic valve implantation (TAVI). To date little is known about the predictive value of the HV-interval prior to TAVI with respect to the risk of AV-block development.
Methods And Results:
HV-interval was determined in 25 consecutive elderly patients with severe aortic valve stenosis (AS) before and immediately after TAVI. All patients subsequently underwent TAVI and 8 of these 25 patients (32%) developed complete AV-block during the TAVI procedure requiring permanent pacemaker implantation. Six of these 8 patients (75%) had marked HV prolongation (>54 ms). Pre-procedural HV-interval was significantly prolonged in the subgroup developing complete AV-block (62.1 ms±13.0 vs 49.2 ms±12.9; P=0.029). Prolongation of the HV-interval above 54 ms was associated with a higher rate of complete AV-block (sensitivity 75.0%, specificity 77.8%, P=0.01).
Conclusions:
HV-interval was prolonged in approximately one third of our elderly patients with aortic valve stenosis and associated with a high rate of complete AV-block following TAVI. HV-interval is easily obtained during TAVI screening procedures, thus facilitating identification of patients at risk for complete AV-block due to TAVI and consequently enabling bespoke risk management.
