The Transcatheter Aortic Valve Replacement-Conduction Study: The Value of the His-Ventricular Interval in Risk...

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.