title: Conduction disturbances after TAVR: Electrophysiological studies and pacemaker dependency.
abstract: BACKGROUND
  Permanent pacemaker (PPM) placement occurs in 5-20% of patients after transcatheter aortic valve replacement (TAVR). Although predictors of pacemaker implantation have been established, features that predispose patients to pacemaker utilization on follow up have not been widely reported.
  
  
  METHODS
  We performed a retrospective review of patients undergoing commercial TAVR between 2011 and 2016. We collated patients that underwent in-hospital PPM implantation and had a follow up of at least 3months. Data abstraction was performed for electrophysiological studies (EPS), pacemaker indication, timing, and device interrogation for pacemaker dependency on follow up.
  
  
  RESULTS
  A total of 24 patients received in-hospital PPM post-TAVR (14% of total cohort), and mean follow up was 22months. Indications for PPM included resting complete heart block (CHB; 15/24, 63%), left bundle branch block and abnormal electrophysiological study (EPS; 7/24, 29%), alternating bundle branch block (1/24, 4%) and tachy-brady syndrome (1/24, 4%). Pacemaker dependency (underlying ventricular asystole, complete heart block, or >50% pacing) occurred in 8/24 patients (33%) during follow-up, 7 of whom had resting CHB, and one with CHB invoked during EPS.
  
  
  CONCLUSIONS
  Pacemaker dependency after TAVR is common among those that exhibited CHB, but not among those with a prolonged HV delay during EPS. Although preliminary, these observations are relevant to management of rhythm disturbances after TAVR, and may inform the practice of EPS-based PPM implantation.
authors.affiliation: Department of Cardiology, Ohio State University Wexner Medical Center, Columbus, OH, 43210.
authors.forename: Nader
authors.initials: N
authors.lastname: Makki
authors.affiliation: Department of Cardiology, Ohio State University Wexner Medical Center, Columbus, OH, 43210.
authors.forename: Jenn
authors.initials: J
authors.lastname: Dollery
authors.affiliation: Department of Cardiology, Ohio State University Wexner Medical Center, Columbus, OH, 43210.
authors.forename: Danielle
authors.initials: D
authors.lastname: Jones
authors.affiliation: Department of Cardiothoracic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210.
authors.forename: Juan
authors.initials: J
authors.lastname: Crestanello
authors.affiliation: Department of Cardiology, Ohio State University Wexner Medical Center, Columbus, OH, 43210. Electronic address: Scott.Lilly@osumc.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Lilly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Conduction disturbances; Electrophysiological studies; Pacemaker dependency; TAVI