title: The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring.
abstract: 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.
  
  
  
  Little is known about predictors and timing of high-degree AVB.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: stefan.toggweiler@luks.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.affiliation: Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Erik
authors.initials: E
authors.lastname: Holy
authors.affiliation: Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zuk
authors.affiliation: Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Florim
authors.initials: F
authors.lastname: Cuculi
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Sabti
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Raluca
authors.initials: R
authors.lastname: Suciu
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.affiliation: Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Peiman
authors.initials: P
authors.lastname: Jamshidi
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.affiliation: Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D013557:Switzerland; D013686:Telemetry; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: aortic stenosis; conduction disorders; heart block; transcatheter aortic valve replacement