title: The value of electrophysiologic study in decision-making regarding the need for pacemaker implantation after TAVI.
abstract: OBJECTIVE
  The purpose of this study was to evaluate electrophysiologic study (EPS) in risk stratification of relative indications for pacemaker implantation (PMI) after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  We reviewed files of all patients who had a left bundle branch block (LBBB) and underwent EPS after TAVI between 3/2009 and 5/2015. The indications for EPS were new-onset LBBB and the presence of an old or a new-onset LBBB associated with either PR prolongation after TAVI (∆PR >20 ms) or with "slow" atrial fibrillation (<100/min). Pacemakers were implanted when significant infranodal disease was demonstrated. The control group comprised of 55 consecutive patients who underwent TAVI and had an indication for an EPS per our definitions. These patients were discharged without further intervention. All patients were followed during 1 year for the composite endpoint of mortality or PMI after hospital discharge.
  
  
  RESULTS
  Indications for EPS were new LBBB (n = 8, 30.8%), new LBBB + ∆PR >20 ms (n = 9, 34.6%), baseline LBBB + ∆PR >20 ms (n = 7, 26.9%) and new LBBB + slow AF <100 bpm (n = 2, 7.7%). Multilevel conduction disturbances involving the AV node (n = 19, 73.1%), the His (n = 3, 11.5%), and the infra-His system (n = 4, 15.4%) were found. Post discharge, there were 5 (9%) deaths and 3 (5.5%) PMI in the control group compared to none in the EPS group corresponding to event-free survival of 85 and 100%, respectively (p = 0.04).
  
  
  CONCLUSIONS
  Patients with LBBB with or without ∆PR >20 ms are at a higher risk of mortality and late PMI at 1-year follow-up. EPS can be used to safely identify patients in whom a PMI is needed.
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Oholi
authors.initials: O
authors.lastname: Tovia-Brodie
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Ben-Haim
authors.affiliation: Department of Hemato-oncology, Rabin Medical Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Erel
authors.initials: E
authors.lastname: Joffe
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Glick
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
authors.affiliation: Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. ymichowitz@gmail.com.|Department of Cardiology, Tel-Aviv Sourasky Medical Center, Weizman St 6, Tel-Aviv, 64239, Israel. ymichowitz@gmail.com.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Michowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D015984:Causality; D000066491:Clinical Decision-Making; D015897:Comorbidity; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000534:rehabilitation; D016896:Treatment Outcome
keywords: Conduction disturbances; EPS; Pacemaker; TAVI