Immediate Post-Procedural 12-Lead Electrocardiography as Predictor of Late Conduction Defects After Transcatheter Aortic Valve Replacement

OBJECTIVES The aim of this study was to use a 12-lead electrocardiogram obtained immediately post-transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR. BACKGROUND There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR. METHODS A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR. RESULTS Self-expandable, mechanical, or balloon-expandable heart valves were implanted in 328 (70%), 61 (13%), and 78 (17%) patients, respectively. For patients in sinus rhythm without right bundle branch block, late HD-CD developed in 0 of 70 patients (0%; 95% confidence interval [CI]: 0% to 5.1%) with PR interval < 200 ms and QRS interval < 120 ms and in 5 of 109 patients (4.6%; 95% CI: 1.5% to 10.4%; all with sufficient escape rhythm) with PR interval < 240 ms and QRS interval < 150 ms. Late HD-CD developed in 14 of 101 patients (13.9%; 95% CI: 7.8% to 22.2%; 6 with insufficient escape rhythm [5.9%; 95% CI: 2.2% to 12.5%]) with PR interval >= 240 ms or QRS interval >= 150 ms. Furthermore, late HD-CD developed in 3 of 49 patients (6.1%; 95% CI: 1.3% to 16.9%; all with sufficient escape rhythm) and in 3 of 30 patients (10.0%; 95% CI: 2.1% to 26.5%; 2 with insufficient escape rhythm [6.7%; 95% CI: 0.8% to 22.1%]) with atrial fibrillation and no right bundle branch block with QRS interval < 140 and >= 140 ms, respectively. CONCLUSIONS On the basis of immediate post-TAVR 12-lead electrocardiography, removing the temporary pacemaker immediately following TAVR is potentially safe in patients without right bundle branch block who are: 1) in sinus rhythm with PR interval < 240 ms and QRS interval < 150 ms; or 2) in atrial fibrillation with a QRS interval < 140 ms. (C) 2018 by the American College of Cardiology Foundation.