Conduction disturbances and permanent pacemaker implantation in patients undergoing TAVI with a minimalist approach

ABSTRACT

INTRODUCTION: The development of conduction disturbances and the need for permanent pacemaker (PPM) implantation are among the most common complications related to TAVI. Nowadays, a minimalist TAVI approach is favored, with the goal to promote a safer, timely hospital discharge < 48 hours. Accordingly, the occurrence of conduction disturbances after the procedure must be systematically monitored. OBJECTIVE: To evaluate the prevalence of baseline electrocardiographic (EKG) abnormalities known to predict conduction disorders after TAVI and the incidence of PPM within 30 days after the procedure, in unselected patients (pts) undergoing a minimalist TAVI procedure in a tertiary hospital of the SUS. METHODS: Single center, observational and prospective study, with consecutive pts undergoing minimalist TAVI from Sep/2020 to Jan/2022. EKG was obtained at baseline and at the end of the procedure, 4h and 24 h after TAVI, according to institutional protocol. The presence of rhythm disturbances, atrioventricular and intraventricular blocks and the indication of PPM during index hospitalization and after 30 days were analysed. RESULTS: Fifty patients were selected, with a mean age of 79.2±4.8 years and a mean STS of 2.6±1.4%; 20 (40%) were women. Balloon-expandable transcatheter heart valves (THV) were used more frequently (76%), and a high-positioning implantation technique of THV were attemped. The rhythm and conduction disturbances at baseline were - Sinus rhythm 41 (82%) - Atrial fibrillation 12 (24%) - BAV 1st degree 14 (28%) - Right bundle branch block 3 (6%) - Left bundle branch block 7 (14%) - Pacemaker 4 (8%). The occurrence of bradyarrhythmias that motivated extended monitoring and in-hospital surveillance for at least 24 hours occurred in 7 (14%) pcts, as follows Total atrioventricular block 1 (2.5%) - Advanced atrioventricular block 1 (2.5%) - Atrial fibrillation with slow ventricular response 2 (5%) - Junctional rhythm 2 (5%) - Sinus bradycardia and intraventricular conduction disorder 1 (2.5%) There was an indication for PPM in only 1 (2.5%) pct. There were no readmissions due to conduction disorders or PPM implantation up to 30 days after TAVI. CONCLUSION: In this series, few patients undergoing TAVI with a minimalist approach had conduction disturbances that resulted in a delay of hospital discharge. Only 1 pct required PM implantation. The application of an institutional protocol with timely hospital discharge (<48h) was not related to a higher risk of conduction disturbances in the short term (30 days).