Prospective Evaluation of a Simplified Discharge and Temporary Pacing Algorithm After Transcatheter Aortic Valve...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Increasing patient volumes in transcatheter aortic valve replacement (TAVR) necessitate streamlined procedures and shorter hospital stays.
• Ensuring patient safety during and after TAVR is paramount, even with accelerated discharge protocols.

Purpose of the Study:

• To prospectively evaluate a novel electrocardiogram (ECG)-based algorithm for discharge planning in TAVR patients.
• To assess the algorithm's impact on the utilization of temporary pacemakers (TPMs) in pacemaker-naïve TAVR recipients.

Main Methods:

• Patients were stratified into discharge groups (next-day, second-day, third-day) based on preprocedural and postprocedural ECG findings.
• Prophylactic TPM use was restricted to patients with pre-existing right bundle branch block or prolonged PQ interval (>250 ms).

Main Results:

• Of 664 TAVR patients, 69.8% were discharged as planned or earlier.
• The algorithm reduced the need for TPMs from 39.2% (consensus criteria) to 4.5% without compromising safety.
• Permanent pacemaker (PPM) implantation occurred in 11.5% of patients, with a 2.0% 30-day readmission rate for PPMs.

Conclusions:

• An ECG-based discharge algorithm effectively enables postimplant discharge planning for TAVR patients.
• This algorithm significantly reduces temporary pacemaker use while maintaining safety during hospitalization and post-discharge.
• Streamlining TAVR discharge protocols is feasible and safe using ECG criteria and judicious TPM management.