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The value of electrophysiologic study in decision-making regarding the need for pacemaker implantation after TAVI

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Abstract

Purpose

The purpose of this study was to evaluate electrophysiologic study (EPS) in risk stratification of relative indications for pacemaker implantation (PMI) after transcatheter aortic valve implantation (TAVI).

Methods

We reviewed files of all patients who had a left bundle branch block (LBBB) and underwent EPS after TAVI between 3/2009 and 5/2015. The indications for EPS were new-onset LBBB and the presence of an old or a new-onset LBBB associated with either PR prolongation after TAVI (∆PR >20 ms) or with “slow” atrial fibrillation (<100/min). Pacemakers were implanted when significant infranodal disease was demonstrated. The control group comprised of 55 consecutive patients who underwent TAVI and had an indication for an EPS per our definitions. These patients were discharged without further intervention. All patients were followed during 1 year for the composite endpoint of mortality or PMI after hospital discharge.

Results

Indications for EPS were new LBBB (n = 8, 30.8%), new LBBB + ∆PR >20 ms (n = 9, 34.6%), baseline LBBB + ∆PR >20 ms (n = 7, 26.9%) and new LBBB + slow AF <100 bpm (n = 2, 7.7%). Multilevel conduction disturbances involving the AV node (n = 19, 73.1%), the His (n = 3, 11.5%), and the infra-His system (n = 4, 15.4%) were found. Post discharge, there were 5 (9%) deaths and 3 (5.5%) PMI in the control group compared to none in the EPS group corresponding to event-free survival of 85 and 100%, respectively (p = 0.04).

Conclusions

Patients with LBBB with or without ∆PR >20 ms are at a higher risk of mortality and late PMI at 1-year follow-up. EPS can be used to safely identify patients in whom a PMI is needed.

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Authors and Affiliations

  1. Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Oholi Tovia-Brodie, Yael Ben-Haim, Ariel Finkelstein, Aharon Glick, Raphael Rosso, Bernard Belhassen & Yoav Michowitz

  2. Department of Hemato-oncology, Rabin Medical Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Erel Joffe

  3. Department of Cardiology, Tel-Aviv Sourasky Medical Center, Weizman St 6, Tel-Aviv, 64239, Israel

    Yoav Michowitz

Authors
  1. Oholi Tovia-Brodie
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  2. Yael Ben-Haim
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  3. Erel Joffe
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  4. Ariel Finkelstein
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  5. Aharon Glick
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  6. Raphael Rosso
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  7. Bernard Belhassen
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  8. Yoav Michowitz
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Corresponding author

Correspondence to Yoav Michowitz.

Ethics declarations

Informed consent was obtained from all individual participants included in the study, and the study was approved by the Institutional Ethics Committee.

Funding

There was no funding for this study.

Conflict of interest

Dr. Finkelstein acts as a TAVI proctor and receives consultation fees from Medtronic cardiovascular (Minneapolis, Minnesota) and Edwards Lifesciences (Irvine, California). All other authors declare that they have no conflict of interest.

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Tovia-Brodie, O., Ben-Haim, Y., Joffe, E. et al. The value of electrophysiologic study in decision-making regarding the need for pacemaker implantation after TAVI. J Interv Card Electrophysiol 48, 121–130 (2017). https://doi.org/10.1007/s10840-016-0218-2

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  • DOI: https://doi.org/10.1007/s10840-016-0218-2

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