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Evaluation of the incidence, timing, and potential recovery rates of complete atrioventricular block after transcatheter aortic valve implantation: a Japanese multicenter registry study

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Abstract

Data on the accurate onset date and serial changes of the complete atrioventricular block (CAVB) after transcatheter aortic valve implantation (TAVI) are limited. This study aimed to assess the incidence, timing, and potential recovery of CAVB following TAVI. Total 696 patients who underwent TAVI were enrolled. Acute CAVB was evaluated within 24 h; delayed CAVB was evaluated 24 h after TAVI. Recovered CAVB was defined as ventricular pacing < 1% during the follow-up or transit block without the need for permanent pacemaker implantation (PMI). The other patients with CAVB were categorized as continued CAVB. Clinical differences between the recovered and continued CAVB groups were evaluated, and the predictive factors of continued CAVB were assessed. The incidence rates of CAVB, acute CAVB, and delayed CAVB were 6.9% (48/696), 4.6% (32/696), and 2.3% (16/696), respectively. Overall, 47.9% (23/48) of patients had recovered CAVB, which was more prevalent in the acute CAVB group than in the delayed CAVB group [59.4% (19/32) vs. 25.0% (4/16), p = 0.025]. CAVB recovery occurred within 24 h (61.0%, 14/23) and after 24 h (39.0%, 9/23). Before CAVB recovery, 21.7% (5/23) of patients had already undergone PMI. A pre-existing complete right bundle branch block (CRBBB) was the only independent predictive factor of continued CAVB (odds ratio 4.51, 95% confidence interval 1.03–19.6, p = 0.045). In conclusion, a pre-existing CRBBB and the timing and prolonged duration of CAVB may be used in risk stratification to determine the appropriateness of early discharge, optimal PMI date, and PMI indication.

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Authors and Affiliations

  1. Department of Cardiology, Toyohashi Heart Canter, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan

    Ai Kagase, Masanori Yamamoto, Tetsuro Shimura & Atsuko Kodama

  2. Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan

    Masanori Yamamoto, Seiji Kano & Yutaka Koyama

  3. Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan

    Norio Tada

  4. Department of Cardiology, New Tokyo Hospital, Chiba, Japan

    Kensuke Takagi

  5. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan

    Motoharu Araki

  6. Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan

    Futoshi Yamanaka

  7. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan

    Shinichi Shirai

  8. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan

    Yusuke Watanabe

  9. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

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  1. Ai Kagase
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  8. Kensuke Takagi
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Correspondence to Masanori Yamamoto.

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Kagase, A., Yamamoto, M., Shimura, T. et al. Evaluation of the incidence, timing, and potential recovery rates of complete atrioventricular block after transcatheter aortic valve implantation: a Japanese multicenter registry study. Cardiovasc Interv and Ther 36, 246–255 (2021). https://doi.org/10.1007/s12928-020-00670-6

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  • DOI: https://doi.org/10.1007/s12928-020-00670-6

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