Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation to predict the need for permanent pacing.

Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing. A retrospective analysis was conducted of 209 consecutive TAVI patients seen from January 2012 to December 2015 at Baylor Heart and Vascular Hospital, Dallas. The baseline characteristics were similar between those who received a permanent pacemaker (PPM) within 7 days of the procedure (21.1%) and those who did not (78.9%); of those who did receive a PPM, 79.5% were implanted for complete heart block. The median (range) percentage change in the sum of QRS and PR was significantly higher in those who received a PPM (20.2%) than those who did not (7.1%) (P = 0.004). Using the percentage change in the sum of QRS and PR to predict PPM, the area under the curve was found to be 0.69. The optimal cutpoint was found to be 18.9% (sensitivity = 0.63, specificity = 0.73). Our study suggests that delay in the conduction system immediately following TAVI predicts the need for permanent pacing.