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Atrioventricular conduction in patients undergoing pacemaker implant following self‐expandable transcatheter aortic valve replacement
Author(s) -
Ghannam Michael,
Cunnane Ryan,
Menees Daniel,
Grossman Michael P.,
Chetcuti Stanley,
Patel Himanshu,
Deeb Michael,
Jongnarangsin Krit,
Pelosi Frank,
Oral Hakan,
Latchamsetty Rakesh
Publication year - 2019
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13694
Subject(s) - medicine , cardiology , atrioventricular block , valve replacement , cardiac skeleton , heart block , conduction abnormalities , electrical conduction system of the heart , odds ratio , implant , surgery , aortic valve replacement , electrocardiography , stenosis
Background Heart block requiring a pacemaker is common after self‐expandable transcatheter aortic valve replacement (SE‐TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown. Objective To evaluate the long‐term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE‐TAVR. Methods All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE‐TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow‐up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery. Results Following SE‐TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow‐up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long‐term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28–0.86]/mm, P = 0.02) predicted lack of conduction recovery. Conclusions Half of the patients undergoing CIED placement for heart block following SE‐TAVR recovered AV conduction within several months and maintained this over an extended follow‐up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.