Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology | 2019
Need for pacemaker implantation in patients with normal QRS duration immediately after transcatheter aortic valve implantation.
Abstract
AIMS\nWe sought to assess the need for permanent pacemaker implantation (PPI) in patients with QRS <120\u2009ms in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI).\n\n\nMETHODS AND RESULTS\nWe retrospectively analysed 1139 consecutive patients who underwent transfemoral TAVI between 2008 and 2016, receiving different valve types. All patients were surveyed by continuous ECG monitoring for 48\u2009h, 12-lead ECGs starting immediately after procedure, as well as 24-h Holter recording the day before discharge. Indication for PPI was at the discretion of the attending physician. Among 760 patients with QRS <120\u2009ms prior to the TAVI procedure, 400 patients showed QRS <120\u2009ms immediately after procedure, whereas 360 patients had QRS ≥120\u2009ms. In the group with QRS <120\u2009ms, PPI was performed in 34 patients [8.5%; 95% confidence interval (CI) 5.6-11.2%] during the first week. Eight of the PPIs in the group with QRS <120\u2009ms (2%; CI 0.8-3.5%) fulfilled Class I indications for PPI after TAVI, whereas 26 PPIs had different indications [left bundle branch block, sick sinus, low-grade atrioventricular (AV) block]. Complete AV block developed in three patients of the group of QRS <120\u2009ms (0.75%; CI 0.0-1.7%), which in all cases occurred after the 48\u2009h-surveillance period. During 1-year follow-up, 11 PPIs were performed (2.8%; CI 1.2-4.5%), thereof three PPI for Class I indications including one complete AV block.\n\n\nCONCLUSION\nIn patients with QRS duration <120\u2009ms immediately after TAVI, the risk for complete AV block was low during the first week after TAVI and 1-year follow-up.