Baseline HV-interval predicts complete AV-block secondary to transcatheter aortic valve implantation

Abstract

Purpose Development of AV-block is a frequent complication associated with transcatheter aortic valve implantation (TAVI). To date little is known about the predictive value of the HV-interval prior to TAVI with respect to the risk of AV- block development.

Methods and results HV-interval was determined in 25 consecutive elderly patients with severe aortic valve stenosis (AS) before and immediately after TAVI. All patients subsequently underwent TAVI and 8 of these 25 patients (32%) developed complete AV-block during the TAVI procedure requiring permanent pacemaker implantation. Six of these 8 patients (75%) had marked HV prolongation (> 54 ms). Pre-procedural HV-interval was signifi cantly prolonged in the subgroup developing complete AV-block (62.1 ms ± 13.0 vs 49.2 ms ± 12.9; P = 0.029). Prolongation of the HV-interval above 54 ms was associated with a higher rate of complete AV-block (sensitivity 75.0%, specifi city 77.8%, P = 0.01).

Conclusions HV-interval was prolonged in approximately one third of our elderly patients with aortic valve stenosis and associated with a high rate of complete AV-block following TAVI. HV-interval is easily obtained during TAVI screening procedures, thus facilitating identifi cation of patients at risk for complete AV-block due to TAVI and consequently enabling bespoke risk management.

Key Words:

• TAVI
• aortic valve disease
• complete AV-block
• CoreValve
• HV-interval
• permanent pacemaker