The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

Stefan Toggweiler; Stefan Stortecky; Erik Holy; Katarzyna Zuk; Florim Cuculi; Fabian Nietlispach; Zaid Sabti; Raluca Suciu; Willibald Maier; Peiman Jamshidi; Francesco Maisano; Stephan Windecker; Richard Kobza; Peter Wenaweser; Thomas F Lüscher; Ronald K Binder

doi:10.1016/j.jcin.2016.03.024

The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring

JACC Cardiovasc Interv. 2016 Jun 27;9(12):1269-1276. doi: 10.1016/j.jcin.2016.03.024. Epub 2016 Jun 20.

Authors

Stefan Toggweiler¹, Stefan Stortecky², Erik Holy³, Katarzyna Zuk², Florim Cuculi⁴, Fabian Nietlispach³, Zaid Sabti⁴, Raluca Suciu³, Willibald Maier³, Peiman Jamshidi⁴, Francesco Maisano³, Stephan Windecker², Richard Kobza⁴, Peter Wenaweser², Thomas F Lüscher³, Ronald K Binder³

Affiliations

¹ Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: [email protected].
² Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
³ Heart Center, University Hospital Zurich, Zurich, Switzerland.
⁴ Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.

PMID: 27339844
DOI: 10.1016/j.jcin.2016.03.024

Abstract

Objectives: The study sought to identify predictors for delayed high-degree atrioventricular block (AVB) in patients undergoing transcatheter aortic valve replacement (TAVR) and determine the need and required duration of telemetry monitoring.

Background: Little is known about predictors and timing of high-degree AVB.

Methods: A total of 1,064 patients (52% women) without a permanent pacemaker undergoing TAVR at 3 centers in Switzerland were investigated. Electrocardiograms (ECGs) at baseline and post-TAVR were analyzed to identify atrioventricular and interventricular conduction disorders.

Results: Periprocedural high-degree AVB occurred in 92 (8.7%), delayed high-degree AVB in 71 (6.7%), up to 8 days post-procedure. In multivariate analysis, delayed high-degree AVB occurred more frequently in men (odds ratio: 2.4, 95% confidence interval: 1.3 to 4.5; p < 0.01), and in patients with conduction disorders post-TAVR (odds ratio: 10.8; 95% confidence interval: 4.6 to 25.5; p < 0.01). Patients in sinus rhythm without conduction disorders post-TAVR did not develop delayed high-degree AVB (0 of 250, 0%). Similarly, the risk in patients with atrial fibrillation but no other conduction disorders was very low (1 of 102, 1%). There was no patient developing delayed high-degree AVB who had a stable ECG for 2 days or more.

Conclusion: Patients without conduction disorders post-TAVR did not develop delayed high-degree AVB. Such patients may not require telemetry monitoring. All other patients should be monitored until the ECG remains stable for at least 2 days. This algorithm should be validated in a separate patient population.

Keywords: aortic stenosis; conduction disorders; heart block; transcatheter aortic valve replacement.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Aged, 80 and over
Algorithms
Aortic Valve / physiopathology
Aortic Valve / surgery*
Atrioventricular Block / diagnosis*
Atrioventricular Block / etiology
Atrioventricular Block / physiopathology
Chi-Square Distribution
Decision Support Techniques
Electrocardiography, Ambulatory / methods*
Female
Humans
Male
Multivariate Analysis
Odds Ratio
Patient Selection
Predictive Value of Tests
Risk Factors
Switzerland
Telemetry*
Time Factors
Transcatheter Aortic Valve Replacement / adverse effects*
Treatment Outcome