title: Respective role of surface electrocardiogram and His bundle recordings to assess the risk of atrioventricular block after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Atrioventricular block (AVB) is common after transcatheter aortic valve replacement (TAVR) and permanent pacemaker (PPM) implantation is needed in up to 30% of patients. Main predictors of long term AVB are electrocardiographic. The purpose of this study is to assess the prognostic value of serial HV intervals measured before and after TAVR to shorten the timing of PPM implantation.
  
  
  METHODS
  His bundle recordings were performed before (HV1), immediately after TAVR (HV2) and at day 2 for Edwards Sapien (ES) and 5 for Medtronic CoreValve (CV) (HV3). PPM indications were high degree AVB before day 5 or prolonged HV interval ≥80ms at the last recording. High degree AVB after discharge was evaluated from the pacemaker memories and ECG at 1 and 6months.
  
  
  RESULTS
  Data were obtained in 84 patients (33% CV and 67% ES). HV values were not associated with early or late AVB. PPM were implanted in 27 patients (34%) for documented AVB (n=17, 24%), prolonged HV interval (n=9) or sick sinus syndrome (n=1). Persistent complete AVB during the procedure and postoperative high degree AVB were the only perioperative factors associated with further long term occurrence of high degree AVB (p=0.001 and p<0.001). On multivariate analysis, only postoperative high degree AVB was significant (p=0.001).
  
  
  CONCLUSIONS
  Pre- and post-operative HV measurements were not correlated with late AVB after TAVR. Perioperative persistent complete AVB and postoperative high degree AVB are the only factors to predict late AVB and should be considered for the decision of PPM implantation.
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France. Electronic address: nicolas.badenco@aphp.fr.
authors.forename: N
authors.initials: N
authors.lastname: Badenco
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Chong-Nguyen
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Maupain
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Himbert
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Duthoit
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Waintraub
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Chastre
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Gandjbakhch
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Hidden-Lucet
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiac Surgery, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Le Prince
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Collet
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Cardiology, 47/83 boulevard de l'Hopital, 75013 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Frank
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000503:physiopathology*; D002036:Bundle of His / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000639:trends*
keywords: Atrioventricular block; Electrophysiological study; Permanent pacemaker implantation; Transcatheter aortic valve implantation