0281: His bundle recording during and after TAVR to predict early and late atrio-ventricular block

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• 作者：Nicolas Badenco ; ^{nicolas.badenco@psl.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Caroline Nguyen ; Robert Frank ; G. Duthoit ; Carole Maupain ; Franç ; oise Hidden-Lucet ; Pascal Leprince ; E. Gandjbakhch ; Xavier Waintraub ; Jean-Philippe Collet
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：8
• 期：1
• 页码：51
• 全文大小：47 K

文摘

Early and late atrioventricular blocks (AVB) are frequent during trans-aortic valve replacement (TAVR) leading to permanent pacemaker (PPM) implantation.

Whether His Bundle recording (HBR) during and after TAVR can predict AVB remains a matter of debate.

Objective

To correlate HV interval during and after TAVR with early and late AVB occurrence.

Methods

Between January 2013 and December 2014, HBR was assessed prospectively before balloon inflation (HV1), 15minutes after (HV2), and at day 2 and 5 for Sapiens and CoreValve (HV3) in all pacemaker-free patients undergoing TAVR. PPM was implanted when permanent AVB persisted over day, or if paroxystic AVB occurred within the first 5 days or if HV3 >80ms. Logistic regression was performed to assess if HVB could well predict early (from day 1 to day 5) or late (from day 5 to day 30) AVB occurrence.

Results

86 patients aged of 85±8,2 years old, with a Euroscore of 15,3±9,3 and of whom 50(79%) were female were recruited. Corevalve was predominantly used (59(66%)). HV1, HV2 and HV3 were 56±9ms, 70±19ms and 63±14ms respectively. In total, 29 (34%) PPM were implanted before discharge of which 18 (19,7%) for documented AV bloc, 8 for prolonged HV interval and 3 for sick sinus syndrome. 12 patients (13,9%) showed AVB during follow-up after discharge, all implanted for early AVB. There was no AVB recorded in PPM for prolonged HV interval, programmed with a diagnostic atrio-ventricular conduction preservation algorithm. HV1 and HV2 were not associated with early AVB occurrence (p=0,79 and p=0,34 respectively).

Prolonged HV1, HV2 or HV3 did not predict late AVB occurrence either (p=0,54, p=0,90 and p=0,91 respectively).

Conclusion

High degree AVB is a common finding after TAVR and can occur late. Repeated HBR before and after TAVR did not show any significant predictive value for early and delayed AVB.