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

Toggweiler, Stefan; Stortecky, Stefan; Holy, Erik; Zuk, Katarzyna; Cuculi, Florim; Nietlispach, Fabian; Sabti, Zaid; Suciu, Raluca; Maier, Willibald; Jamshidi, Peiman; Maisano, Francesco; Windecker, Stephan; Kobza, Richard; Wenaweser, Peter Martin; Lüscher, Thomas F; Binder, Ronald K (2016). The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring. JACC. Cardiovascular Interventions, 9(12), pp. 1269-1276. Elsevier 10.1016/j.jcin.2016.03.024

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Stortecky, Stefan; Zuk, Katarzyna; Nietlispach, Fabian; Windecker, Stephan and Wenaweser, Peter Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

23 Dec 2016 14:21

Last Modified:

23 Dec 2016 14:21

Publisher DOI:

10.1016/j.jcin.2016.03.024

PubMed ID:

27339844

Uncontrolled Keywords:

aortic stenosis; conduction disorders; heart block; transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.89712

URI:

https://boris.unibe.ch/id/eprint/89712

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