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Electrophysiological Study-Guided Permanent Pacemaker Implantation in Patients With Conduction Disturbances Following
Hamed Bourenane1, Vincent Galand1, Dominique Boulmier1
1Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France.
Insights
Electrophysiological studies (EPS) effectively guide permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI). This strategy safely identifies patients who can avoid PPM, improving post-TAVI conduction disturbance management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Conduction disturbances are frequent after transcatheter aortic valve implantation (TAVI).
- Optimal management strategies for these disturbances, particularly high-degree atrioventricular block (HAVB), are not well-established.
- Invasive electrophysiological studies (EPS) show potential for risk stratification.
Purpose of the Study:
- To evaluate the safety and diagnostic performance of an EPS-guided permanent pacemaker (PPM) implantation strategy.
- To assess the utility of EPS in managing conduction disturbances post-TAVI in patients without absolute indications for PPM.
Main Methods:
- Retrospective analysis of TAVI recipients who underwent EPS during index hospitalization (June 2017-July 2020).
- Defined false negative (PPM required within 6 months) and false positive (low ventricular pacing) outcomes.
- Calculated sensitivity, specificity, and predictive values of the EPS-guided strategy.
Main Results:
- 78 patients included; 35 (45%) received PPM post-EPS.
- EPS-guided strategy demonstrated 100% sensitivity and 89.6% specificity for predicting HAVB requiring PPM.
- Negative and positive predictive values were 100% and 81.5%, respectively. Six patients with mechanical HAVB during EPS required PPM and showed dependency.
Conclusions:
- An EPS-guided PPM implantation strategy is effective for managing post-TAVI conduction disturbances.
- This approach accurately identifies patients who can be safely discharged without a PPM.
- EPS provides valuable risk stratification for TAVI recipients with conduction abnormalities.
Abstract:
Conduction disturbances remain common following transcatheter aortic valve implantation (TAVI). Aside from high-degree atrioventricular block (HAVB), their optimal management remains elusive. Invasive electrophysiological studies (EPS) may help stratify patients at low or high risk of HAVB allowing for an early discharge or permanent pacemaker (PPM) implantation among patients with conduction disturbances. We evaluated the safety and diagnostic performances of an EPS-guided PPM implantation strategy among TAVI recipients with conduction disturbances not representing absolute indications for PPM. All patients who underwent TAVI at a single expert center from June 2017 to July 2020 who underwent an EPS during the index hospitalization were included in the present study. False negative outcomes were defined as patients discharged without PPM implantation who required PPM for HAVB within 6 months of the initial EPS. False positive outcomes were defined as patients discharged with a PPM with a ventricular pacing percentage <1% at follow-up. A total of 78 patients were included (median age 83.5, 39% female), among whom 35 patients (45%) received a PPM following EPS. The sensitivity, specificity, positive and negative predictive values of the EPS-guided PPM implantation strategy were 100%, 89.6%, 81.5%, and 100%, respectively. Six patients suffered a mechanical HAVB during EPS and received a PPM. These 6 patients showed PPM dependency at follow-up. In conclusion, an EPS-guided PPM implantation strategy for managing post-TAVI conduction disturbances appears effective to identify patients who can be safely discharged without PPM implantation.
