Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Indications D-PO03 - Poster Session III (ID 48) Poster

D-PO03-079 - Clinical Management Of Heart Block During Transcatheter Aortic Valve Replacement (ID 310)

 K. Tandon: Nothing relevant to disclose.


Background: Transcatheter aortic valve replacement (TAVR) includes risks for heart block (HB). Optimal strategies for managing peri-procedural HB remain controversial.
Objective: To identify the impact of transient and persistent heart block during TAVR on subsequent need for pacemaker (PPM) implantation.
Methods: All patients without pre-existing PPM who had a TAVR implant at Beth Israel Deaconess Medical Center (BIDMC) from 06/2015 - 10/2019 were evaluated to identify cases of HB occurring during the procedure. Transient HB was defined as block resolving acutely during TAVR and persistent HB as block still present at the end of TAVR. Subsequent progression of conduction disease and need for PPM implantation were assessed through chart review.
Results: Of 766 patients receiving TAVR, 649 met enrollment criteria. Transient HB occurred in 32 (5%), of whom 14 (43.8%) required PPM implantation: 10 during index admission (8/10 for recurrent HB; 2 for high risk ECG features); and 4 post-discharge (all for recurrent HB). An additional 43 patients (6.6%) developed persistent HB during TAVR and received a temporary pacemaker. Of these, 41/43 (95.3%) had PPM placed during the index admission (36/41 due to persistent HB in hospital and the remaining 5/41 for high risk ECG, delayed recovery of HB, or infra-his block on EPS). Both patients who did not get a PPM had AV conduction recovery <24 hours after TAVR without recurrent HB while in the hospital or in follow-up.
Conclusion: Transient HB is strongly associated with subsequent delayed HB, and nearly all patients with HB at end of their TAVR ultimately needed PPMs, suggesting little benefit to monitor for recovery of conduction for a prolonged period.