title: Electrocardiographic Predictors of Long-Term Cardiac Pacing Dependency Following Transcatheter Aortic Valve Implantation.
abstract: Conduction disorders requiring permanent pacemaker (PPM) implantation are a known complication of transcatheter aortic valve implantation (TAVI). Indications for permanent pacing in this setting are still controversial. The study aim was to characterize the natural history of conduction disorders related to TAVI, and to identify predictors for long-term pacing dependency.
  
  
  
  Consecutive patients who underwent TAVI were included in this prospective observational study. The conduction system was investigated by reviewing 12-lead ECGs during hospitalization and up to 1-year follow-up and by analyzing pacemaker interrogation data. Multivariate analysis was performed in order to identify independent predictors for pacemaker dependency.
  
  
  
  Of 110 patients included in the analysis, 38 (34.5%) underwent PPM implantation. Of those, 26 (68.4%) had a long-term pacing dependency (required PPM), while 12 (31.6%) did not (not-required PPM). Logistic regression revealed that baseline RBBB (P = 0.01, OR = 18.0), baseline PR interval (P = 0.019, OR = 1.14), post-TAVI PR interval and the change in PR interval from baseline (P < 0.001 for both, OR = 1.17 for each 10 milliseconds increment) were independent predictors for long-term pacing dependency. A PR interval increment of greater than 28 milliseconds had the best accuracy in predicting pacemaker dependency.
  
  
  
  Increased pre- and postprocedural PR intervals and pre-existing RBBB are reliable predictors for long-term PPM dependency, while left bundle branch block or QRS width are misleading factors. Our study suggests that the decision for implanting PPM after TAVI should be based mostly on the prolongation of the PR interval.
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Sivan
authors.initials: S
authors.lastname: Naveh
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Gidon Y
authors.initials: GY
authors.lastname: Perlman
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Elitsur
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Planer
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Leibowitz
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Danenberg
authors.affiliation: The Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ronny
authors.initials: R
authors.lastname: Alcalai
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: aortic stenosis; conduction system; heart block; permanent pacemaker; transcatheter aortic valve implantation