Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement

Stephen Cresse, Trevor Eisenberg, Carlos E Alfonso, Mauricio G Cohen, Eduardo De Marchena, Donald Williams, Roger Carrillo

Research output: Contribution to journalArticle

Abstract

Background: Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives: We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker. Methods: This is a single-center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes. Results: Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49–8.37]). Conclusion: Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StatePublished - Jan 1 2019

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Bundle-Branch Block
Heart Block
Electrocardiography
Odds Ratio
Confidence Intervals
Transcatheter Aortic Valve Replacement
Retrospective Studies
Biomarkers

Keywords

  • EKG
  • pacemaker implantation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{6ed4c89bf496497b82eb19a204d3f1d9,
title = "Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement",
abstract = "Background: Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives: We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker. Methods: This is a single-center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0{\%}) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3{\%}). We excluded an additional 50 (8.2{\%}) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes. Results: Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1{\%}, 10.9{\%}, 7.5{\%}, and 3.6{\%}, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95{\%} confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95{\%} CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95{\%} CI: 1.49–8.37]). Conclusion: Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.",
keywords = "EKG, pacemaker implantation, transcatheter aortic valve replacement",
author = "Stephen Cresse and Trevor Eisenberg and Alfonso, {Carlos E} and Cohen, {Mauricio G} and {De Marchena}, Eduardo and Donald Williams and Roger Carrillo",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/pace.13695",
language = "English (US)",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
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TY - JOUR

T1 - Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement

AU - Cresse, Stephen

AU - Eisenberg, Trevor

AU - Alfonso, Carlos E

AU - Cohen, Mauricio G

AU - De Marchena, Eduardo

AU - Williams, Donald

AU - Carrillo, Roger

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives: We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker. Methods: This is a single-center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes. Results: Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49–8.37]). Conclusion: Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.

AB - Background: Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives: We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker. Methods: This is a single-center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes. Results: Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49–8.37]). Conclusion: Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.

KW - EKG

KW - pacemaker implantation

KW - transcatheter aortic valve replacement

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U2 - 10.1111/pace.13695

DO - 10.1111/pace.13695

M3 - Article

JO - PACE - Pacing and Clinical Electrophysiology

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SN - 0147-8389

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