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• W4377012598 abstract "The identification of patients at risk of post-procedural high-grade atrioventricular block (HAVB) is one of the major unmet challenges in transcatheter aortic valve replacement (TAVR). Some studies have suggested that periprocedural electrophysiological (EP) testing might help identify patients at risk, but its role remains controversial. To determine whether pre- and immediate post-valve deployment ECG and HV interval findings are predictive of HAVB and pacemaker (PM) need over 1-year follow-up We prospectively analysed consecutive patients without prior PM implantation undergoing TAVR between August 2019 and October 2021. ECG and standardized HV interval measurements were performed pre- and post-valve deployment with the quadripolar catheter used for rapid pacing. Delta-HV interval was defined as the difference between post- and pre-valve deployment HV intervals). The primary outcome was either documented HAVB beyond 24h after TAVR or ventricular pacing >1% in patients who underwent prophylactic PM implantation because of abnormal EP testing within the days following TAVR. Minimal follow-up duration was 12 months. 97 patients were included. The primary outcome occurred in 8 patients (8.3%): HAVB occurred in 7 patients (5 during hospitalisation and 2 within one month of follow-up), and 1 patient underwent PM implantation because of abnormal EP testing (HV interval ≥70ms) with ventricular pacing up to 11% despite an algorithm to minimize pacing. Among ECG and EP findings, univariate predictors of the primary outcome were the pre- and post-valve deployment PR interval and both the post-valve deployment HV and Delta-HV interval (Table 1). By ROC analysis, a Delta-HV interval ≥18ms predicted HAVB with 50% sensitivity and 90% specificity (AUC=0.708, PPV 31%), and an HV interval ≥60ms after TAVR predicted HAVB with 63% sensitivity and 79% specificity (AUC=0.681, PPV 21%) (Figure 1). None of the patients with a PR interval ≤180 ms after valve deployment experienced the primary outcome. The yield of the periprocedural EP assessment alone is limited in ruling out the risk of HAVB since about half of the patients at risk fail to be identified. However, abnormal post-valve deployment HV or Delta-HV interval help identify a subgroup at particularly high risk developing up to one third of HAVB at follow-up. On the other hand, a PR interval ≤180 ms identifies a subgroup of patients at very low risk, independently of QRS interval and morphology.Tabled 1Table 1 – univariate binary logistic regressionOR [95% CI]p valuePre-ImplantationPRAHHVQRSAxis1.023 [1.002 – 1.045]1.019 [0.998 – 1.042]1.015 [0.914 – 1.127]1.018 [0.992 – 1.044]0.994 [0.977 – 1.012]0.0340.0820.7820.1810.517Post-ImplantationPRAHHVQRSAxis1.007 [1 – 1.035]1.016 [0.995 – 1.038]1.03 [1.004 – 1.057]1.011 [0.984 – 1.038]0.997 [0.981 – 1.0140.0450.1440.0260.4210.754Delta (post - pre implantation)PRAHHVQRSAxis1.002 [0.981 – 1.022]0.988 [0.950 – 1.028]1.033 [1.005 – 1.061]0.995 [0.967 – 1.023]1.003 [0.982 – 1.025]0.8830.5590.0190.7120.754 Open table in a new tab" @default.
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• W4377012598 date "2023-05-01" @default.
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• W4377012598 title "PO-05-132 ROLE OF PERIPROCEDURAL ECG AND ELECTROPHYSIOLOGICAL FINDINGS TO PREDICT HIGH DEGREE ATRIOVENTRICULAR BLOCK AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT" @default.
• W4377012598 doi "https://doi.org/10.1016/j.hrthm.2023.03.1360" @default.
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