Related Experiment Video
Updated: May 12, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
The Transcatheter Aortic Valve Replacement-Conduction Study: The Value of the His-Ventricular Interval in Risk
Mohamad Raad1,2, Joshua Greenberg3, Mahmoud Altawil3
1Structural Heart Disease Section, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Insights
High-degree atrioventricular block (HDAVB) risk after TAVR is predictable using post-procedure His-ventricular (HV) intervals. A post-TAVR HV interval under 65 ms indicates a low risk of HDAVB, especially in patients without baseline RBBB or new LBBB.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Optimal risk stratification for high-degree atrioventricular block (HDAVB) post-transcatheter aortic valve replacement (TAVR) lacks consensus.
- Existing methods do not fully capture the risk of developing HDAVB after TAVR.
Purpose of the Study:
- To evaluate the predictive utility of pre- and post-TAVR His-ventricular (HV) intervals for HDAVB risk.
- To identify optimal timing for assessing HDAVB risk post-TAVR.
Main Methods:
- Prospective electrophysiology study in 121 patients before and after TAVR.
- Primary outcome: HDAVB requiring pacemaker implantation within 30 days.
- Retrospective analysis to determine the postoperative interval with <5% HDAVB risk.
Main Results:
- HDAVB occurred in 10% of patients.
- Predictors of HDAVB included baseline RBBB, implant depth >4 mm, specific valve types, and post-TAVR HV > 65 ms.
- A post-TAVR HV < 65 ms was associated with significantly lower HDAVB risk, particularly in patients without baseline RBBB or new persistent LBBB.
Conclusions:
- Post-TAVR HV interval is a valuable tool for HDAVB risk stratification.
- A post-TAVR HV of ≤ 65 ms is associated with low risk, while ≥ 65 ms indicates higher risk.
- Pre-TAVR HV and delta HV did not offer significant prognostic value.
Background:
There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).
Methods:
This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR. The primary outcome was HDAVB requiring pacemaker implantation within 30 days post-TAVR. A separate retrospective cohort was analyzed to determine the postoperative interval at which the risk of HDAVB is reduced to <5%.
Results:
HDAVB occurred in 12 (10%) patients. Baseline right bundle branch block (RBBB) (odds ratio [OR]: 13.6), implant depth >4 mm (OR: 3.9), use of mechanically- or self-expanding valves (OR: 6.3), and post-TAVR HV > 65 ms (OR: 4.9) were associated with increased risk of HDAVB, whereas PR intervals and pre-TAVR HV were not. In patients without baseline RBBB or new persistent left bundle branch block (LBBB), not one patient with post-TAVR HV < 65 ms developed HDAVB. In the separate retrospective cohort (N = 1049), the risk of HDAVB is reduced (<5%) on postoperative days 4 and 3 in patients with pre-TAVR RBBB and post-TAVR persistent LBBB, respectively.
Conclusions:
Baseline RBBB, new persistent LBBB, implant depth >4 mm, and a post-TAVR HV ≥ 65 ms were associated with a higher risk of post-TAVR HDAVB, whereas an HV ≤ 65 ms was associated with a lower risk. The pre-TAVR HV was not associated with our outcome, and the delta HV did not have practical incremental prognostic value. Among those without pre-TAVR RBBB or post-TAVR persistent LBBB, no patients with post-TAVR HV < 65 ms developed HDAVB.
Related Concept Videos
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies