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Evolution of high‐grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode—that minimizes ventricular pacing—activated
Author(s) -
Irles Didier,
Salerno Fiorella,
Cassagneau Romain,
Eschalier Romain,
Maupain Carole,
Dupuis JeanMarc,
Mansourati Jacques,
Guedon Laurence,
Marijon Eloi,
Frey Pierre
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14970
Subject(s) - medicine , atrioventricular block , cardiology , right bundle branch block , heart block , odds ratio , confidence interval , pr interval , electrocardiography , heart rate , blood pressure
The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high‐grade atrioventricular blocks after TAVI, based on specific pacemaker memory data. Methods and Results STIM‐TAVI (NCT03338582) was a prospective, multicentre, observational study that enrolled all patients (from November 2015 to January 2017) implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of centrally adjudicated late high‐grade atrioventricular blocks during the year after TAVI. Among 197 patients, 138 (70.1%) had ≥1 late high‐grade atrioventricular block. Whereas oversizing ( p = .005), high‐grade atrioventricular block during TAVI ( p < .001), and early (within 6 days) high‐grade atrioventricular block ( p < .001) were associated with occurrence of late high‐grade atrioventricular block, self‐expanding prothesis ( p = .88), prior right bundle branch block ( p = .45), low implantation ( p = .06), and new or wider left bundle branch block and lengthening of PR interval ( p = .24) were not. In multivariable analysis, only post‐TAVI early high‐grade atrioventricular block remained associated with late high‐grade atrioventricular blocks (Days 0–1: odds ratio [OR], 3.25; 95% confidence interval [CI], 1.57–6.74; p = .001; Days 2–6: OR, 4.13; 95% CI, 2.06–8.31; p < .001), whereas other conventionally used predictors were not. Conclusion One‐third of pacemaker‐implanted patients do not experience late high‐grade atrioventricular block. Our findings suggest that post‐TAVI early high‐grade atrioventricular block is the main factor associated with occurrence of late high‐grade atrioventricular blocks.