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Conduction disturbances after TAVR: Electrophysiological studies and pacemaker dependency
Nader Makki1, Jenn Dollery1, Danielle Jones1
1Department of Cardiology, Ohio State University Wexner Medical Center, Columbus, OH, 43210.
Summary
Pacemaker dependency is common after transcatheter aortic valve replacement (TAVR), especially with complete heart block (CHB). Electrophysiological studies (EPS) may help predict which patients need pacemakers long-term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Permanent pacemaker (PPM) placement is common after transcatheter aortic valve replacement (TAVR), affecting 5-20% of patients.
- Predictors for initial PPM implantation are known, but long-term pacemaker utilization requires further investigation.
Purpose of the Study:
- To investigate features predicting pacemaker dependency in patients after TAVR.
- To evaluate the role of electrophysiological studies (EPS) in predicting long-term pacemaker use.
Main Methods:
- Retrospective review of patients undergoing commercial TAVR (2011-2016) who received in-hospital PPM.
- Data collected included EPS findings, PPM indications, timing, and follow-up device interrogation for pacemaker dependency.
- Follow-up duration was at least 3 months.
Main Results:
- 14% of TAVR patients received in-hospital PPM; 33% of these became pacemaker dependent during a mean 22-month follow-up.
- Resting complete heart block (CHB) was the primary indication for PPM and the main predictor of dependency.
- Prolonged HV delay on EPS did not predict pacemaker dependency.
Conclusions:
- Pacemaker dependency after TAVR is frequent in patients with CHB.
- Electrophysiological study findings, specifically prolonged HV delay, may not reliably predict long-term pacemaker dependency.
- These findings can inform management of rhythm disturbances post-TAVR and the utility of EPS-guided PPM implantation.