Role of Routine Electrophysiological Study Performed During Transcatheter Aortic Valve Replacement to Predict AV...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) is increasingly used for aortic stenosis.
• Periprocedural electrophysiological (EP) testing is being explored to predict risks associated with TAVR.
• High-degree atrioventricular block (HAVB) is a significant complication post-TAVR.

Purpose of the Study:

• To evaluate the predictive value of pre- and immediate post-TAVR electrocardiogram (ECG) and HV interval measurements for HAVB.
• To identify specific electrophysiological parameters that can stratify HAVB risk in TAVR patients.

Main Methods:

• Consecutive TAVR patients without prior pacemakers were included.
• Standardized ECG and HV interval measurements were performed pre- and post-TAVR.
• The primary outcome was HAVB or need for ventricular pacing >24 hours post-TAVR.

Main Results:

• A Delta-HV interval ≥18 ms predicted HAVB with 50% sensitivity and 90% specificity.
• An HV interval ≥60 ms post-TAVR showed 63% sensitivity and 79% specificity for HAVB.
• A post-TAVR PR interval ≤180 ms identified patients at very low risk of HAVB.

Conclusions:

• Periprocedural EP assessment during TAVR has limited yield in identifying all at-risk patients for HAVB.
• Early risk stratification is more useful in TAVR patients who develop new-onset LBBB.
• Post-TAVR PR interval ≤180 ms is a reliable indicator of low HAVB risk, irrespective of QRS characteristics.