Abstract 12968: Early AV Conduction Recovery After Pacemaker Placement for High-Degree AV Block Secondary to Transcatheter Aortic Valve Replacement
Introduction: Recovery of conduction has been demonstrated in >50% of patients who receive pacemakers (PPMs) for high-degree atrioventricular block (HDAVB) after trans-catheter aortic valve replacement (TAVR). Little information is available about the time course of conduction recovery in these patients, and there is little comparative data regarding resolution of AV block after balloon-expandable compared to self-expanding valves.
Methods: A retrospective review was performed of patients who underwent TAVR with balloon and self-expanding valves and required PPMs for HDAVB at 2 institutions. Serial PPM interrogations were analyzed to detect recovery of AV conduction. Analysis was performed to identify predictors and timing of conduction recovery.
Results: Of a total population of 578 patients, 54 (9.3%) received PPMs for HDAVB. In multivariate analysis, predictors of HDAVB requiring a PPM included right bundle branch block (OR 5.99 [3.08 -11.6]), atrial fibrillation (OR 1.87 [1.02-3.45]), and self-expanding valves (OR 3.45 [1.85-6.43]). Of the 54 patients who received PPMs, 38 had follow-up sufficient to evaluate AV conduction recovery. Of these, 23 (61%) showed recovery of AV nodal conduction; 20 had already recovered by their first interrogation a median of 22 days (IQR 14-31) post PPM placement (figure). There were no statistically significant predictors of AV nodal conduction recovery, including type of valve implanted. For those who recovered conduction, 9/23 (39%) had ventricular pacing >50% of the time on their final interrogation, of whom 5 had programmed AV intervals <200 msec.
Conclusions: A majority of patients who receive PPMs for HDAVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that longer observation periods may be appropriate after TAVR before PPM implantation, and programming that minimizes ventricular pacing may be beneficial.
Author Disclosures: C.A. Raelson: None. J. Gabriels: None. J. Ruan: None. J.E. Ip: None. G. Thomas: Research Grant; Significant; Biotronik. Speakers Bureau; Modest; Biotronik, St Jude Medical, Medtronic. C.F. Liu: Honoraria; Modest; St Jude Medical. J.W. Cheung: Research Grant; Significant; Biotronik. Honoraria; Modest; Biotronik, Medtronic. B.B. Lerman: None. A. Patel: None. S.M. Markowitz: Honoraria; Modest; Boston Scientific.
- © 2016 by American Heart Association, Inc.