Incidence and Predictors of High-Grade AV Block in Patients With Initially Unchanged Electrocardiogram After TAVR

Background

High-grade atrioventricular block (HAVB) is common after transcatheter aortic valve replacement (TAVR). We compared patients with baseline conduction disease that is unchanged on the immediate post-TAVR echocardiogram (ECG) to patients with normal baseline and post-TAVR ECG (control group).

Methods

Consecutive patients who underwent TAVR at Mayo Clinic (Rochester, Minnesota) between February 2012 and December 2021 were retrospectively reviewed.

Results

In total, 1069 patients were included in the study: 825 controls, 44 with isolated PR of >240 milliseconds, 93 with left bundle branch block (LBBB), and 107 with right bundle branch block (RBBB). Early HAVB (<24 hours post-TAVR) occurred more frequently in the RBBB group compared with controls (11.2% vs 0.6%; P < .001). Early HAVB incidence was similar between the control, isolated PR >240, and LBBB groups (0.6%, 0%, and 1.1%, respectively). Delayed HAVB (>24 hours post-TAVR) was most frequent in the RBBB group (6.5% vs 1.5%; P < .001), with higher incidence also observed in PR >240 and LBBB groups compared with that in control (4.5% vs 1.5%; P = .14; and 4.3% vs 1.5%; P = .06, respectivley). Most of HAVB events in the control, isolated PR >240 and LBBB groups were delayed.

Conclusions

Despite no immediate change in post-TAVR ECG, 17.8% of patients with preexisting RBBB developed HAVB, mostly within 24 hours. This emphasizes the need for inpatient monitoring for at least 24 hours in this group. Conversely, in patients with isolated PR >240 milliseconds and LBBB, the incidence of HAVB was relatively low (5%), with the majority occurring after 24 hours. Potentially, same-day discharge with ambulatory ECG monitoring may be suitable for these patients.