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Updated: Jul 2, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Prospective Evaluation of a Simplified Discharge and Temporary Pacing Algorithm After Transcatheter Aortic Valve
Gulia Faizi1, Edris Faiz1, Fatima Sayid Ali1
1Department of Cardiology, Odense University Hospital, Odense, Denmark.
Background:
The increasing patient volume undergoing transcatheter aortic valve replacement (TAVR) necessitates procedural simplification and short admissions without compromising safety. The objective of this study was to prospectively evaluate a novel electrocardiogram (ECG)-based algorithm for discharge and the use of temporary pacemakers (TPMs) in pacemaker-naïve TAVR patients.
Methods:
Patients were stratified into next-day discharge, second-day discharge, or third-day discharge groups based on preprocedural right bundle branch block and immediate postprocedural ECG changes. Prophylactic TPMs were restricted to patients with pre-existing right bundle branch block or a PQ interval >250 ms.
Results:
Among 664 patients, the mean age was 80.8 ± 5.7 years, 46.0% were females, and 69.8% were discharged as planned or earlier. Self-expandable valves and balloon-expandable valves were used in 28.0 and 72.0%, respectively. The shorter the planned observation, the larger the fraction of discharge delays caused by nonconduction issues (next-day discharge 68.9%, second-day discharge 43.6%, and third-day discharge 10.2%, respectively, p < 0.001). A permanent pacemaker (PPM) was implanted in 11.5%. Although consensus criteria suggested TPMs in 39.2% of cases, the algorithm reduced this to 4.5% without compromising safety. The 30-day readmission rate for PPMs was 2.0%, and no out-of-hospital deaths were related to rhythm disturbances.
Conclusions:
A discharge algorithm based on preprocedure and immediate postprocedure ECG in PPM-naïve patients undergoing TAVR, including a high threshold for TPM insertion, enables postimplant discharge planning in most cases and significantly reduces the use of TPMs without compromising safety during hospitalization or after discharge.
