title: Electrocardiographic and electrophysiological predictors of atrioventricular block after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Electrophysiological predictors of atrioventricular (AV) block after transcatheter aortic valve replacement (TAVR) are unknown.
  
  
  OBJECTIVE
  We sought to assess the value of electrophysiology study before and after TAVR.
  
  
  METHODS
  Seventy-five consecutive pacemaker-free patients undergoing TAVR at the Montreal Heart Institute were prospectively studied.
  
  
  RESULTS
  Eleven patients (14.7%) developed AV block during the index hospitalization and 3 (4.0%) after hospital discharge over a median follow-up of 1.4 years (interquartile range 0.6-2.1 years). AV block developed in 5 of 6 patients with preprocedural right bundle branch block (83.3%), 8 of 30 patients with new-onset left bundle branch block (LBBB; 26.7%), and 1 of 7 patients with preexisting LBBB (14.3%). In multivariate analysis that considered all patients, the delta-HV interval (HV interval after TAVR minus HV interval before TAVR) was the only factor independently associated with AV block. In the subgroup of patients with new-onset LBBB, the postprocedural HV interval was strongly associated with AV block. By receiver operating characteristic analysis, a delta-HV interval of ≥13 ms predicted AV block with 100.0% sensitivity and 84.4% specificity and an HV interval of ≥65 ms predicted AV block with 83.3% sensitivity and 81.6% specificity. In multivariate analysis, the HV interval after TAVR (hazard ratio 1.073 per ms; 95% confidence interval 1.029-1.119; P = .001) was also independently associated with all-cause mortality.
  
  
  CONCLUSIONS
  A prolonged delta-HV interval (≥13 ms) is strongly associated with AV block after TAVR. In patients with new-onset LBBB after TAVR, a postprocedural HV interval of ≥65 ms is likewise predictive of AV block.
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada. Electronic address: lena.rivard@umontreal.ca.
authors.forename: Lena
authors.initials: L
authors.lastname: Rivard
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Gernot
authors.initials: G
authors.lastname: Schram
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shohoudi
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: le Polain de Waroux
authors.affiliation: Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D054537:Atrioventricular Block / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D055724:Electrophysiological Phenomena / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Aortic valve; Aortic valve implantation; Atrioventricular block; Electrophysiology study; Pacemakers