Indication of permanent cardiac pacing after transcatheter aortic valve implantation (TAVISTIM NCT02337140)

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 11; no. 1; pp. 85 - 86
• Main Authors: Brunet, M., Thoman, S., Gandet, T., Massin, F., El Bouazzaoui, R., Macia, J.C., Delseny, D., Granier, M., Piot, C., Robert, G., Albat, Bernard, Leclercq, Florence, Pasquié, Jean-Luc
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2019
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2018.10.188

Regarding the extent of TAVI's indication to patients with intermediary risks, it seems essential to lower its complication. Conduction disturbances after TAVI remains a major complication without any standardized guidelines to help with its treatment. The primary end-point of this study is to confirm that standard criterion for pacing are reliable in post-TAVI conduction disorders and to analyze the contribution of a systematic electrophysiological study. In TAVI patients, indications for pacing were persistent high-degree atrioventricular block or bundle branch block appearance associated to HV interval longer than 70ms, 24hours after the procedure. After a two-month follow-up, clinical and ECG evaluation and 24-hour ECG Holter monitoring were realized in patients without pacemaker and compared to data obtained from the devices in pacemaker implanted patients (% of ventricular pacing>1%; presence of more than 1 AVB episode). A total of 165 consecutive patients who underwent TAVI were prospectively included. Out of the 165 patients included, 157 were sampled: 20 in the high grade persistent AV block, 5 in the persistent bundle branch heart block with HV interval>70ms, 13 with HV interval<70ms, and 119 in the temporary conduction disturbances group. Amongst the 22 patients implanted with PMK following the protocol, only 1 had conduction recovery. On the other hand there were 14 patients who didn’t benefit from a PMK implant but should have. HV interval in the bundle branch block group has an 88% specificity and a 44% sensibility. None of the pacing indication would have been missed if considered at day 3 instead of day 2, independently of HV measurement. From this experimental protocol it appears that an HV based algorithm has a good specificity but a poor sensibility. Conduction disorders are stable at day 3 and allow to decide if pacing is needed. Besides QRS duration, PR interval might be of interest in predicting risk of AV block after TAVI.