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The R-wave amplitude in V1 on baseline electrocardiogram correlates with the occurrence of high-degree

Oren Yagel1,2, Bernard Belhassen1,3, David Planer1,2

  • 1Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 20, 2023
PubMed

Insights

A small R-wave amplitude in lead V1 on a baseline electrocardiogram (ECG) may predict high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR). This finding can help identify patients at higher risk for this complication following left bundle branch block (LBBB).

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly used for aortic stenosis.
  • High-degree atrioventricular block (AVB) is a known complication after TAVR, often requiring permanent pacemaker implantation (PPI).
  • Predictive markers for post-TAVR AVB, especially following new left bundle branch block (LBBB), are crucial for patient management.

Purpose of the Study:

  • To investigate whether baseline R-wave amplitude in the V1 ECG lead predicts high-degree AVB in patients with normal QRS duration undergoing TAVR.
  • To assess the association between R-wave amplitude and the risk of developing high-degree AVB after TAVR, particularly in the context of new LBBB.

Main Methods:

  • Retrospective single-center study of 720 consecutive patients undergoing TAVR.
  • Analysis of 117 patients who developed new LBBB post-TAVR and required PPI for high-degree AVB.
  • Comparison of baseline ECG parameters, specifically R-wave amplitude in lead V1, between patients who developed high-degree AVB and those who did not.

Main Results:

  • A smaller R-wave amplitude in lead V1 was observed in patients who developed high-degree AVB (0.029 ± 0.04 mV) compared to those who did not (0.11 ± 0.14 mV) (P = 0.0316).
  • Receiver-operating characteristic analysis identified a cutoff R-wave amplitude of 0.03 mV for predicting high-degree AVB, with an area under the curve of 0.7219 (P = 0.0002).
  • No significant differences were found in baseline demographics, procedural characteristics, PR interval, QRS duration, or QRS axis between the groups.

Conclusions:

  • Baseline R-wave amplitude in lead V1 is a potential predictor of high-degree AVB following new LBBB after TAVR in patients with normal baseline QRS duration.
  • This ECG marker could aid in identifying patients at increased risk for this complication, potentially guiding prophylactic strategies or closer monitoring.
Abstract

Keywords:
Atrioventricular blockLeft bundle branch blockPermanent pacemaker implantationTranscatheter aortic valve replacement

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