Late Onset of New Conduction Disturbances Requiring Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation

Background The timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown; however, they are essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late-onset CDs requiring PPI to identify patients suitable for safe early discharge (<48 h) following TAVI. Methods We retrospectively analyzed data from 5 large-volume centers in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated to identify the onset of new CDs in all patients who required a PPI within 30 days after TAVI. Early-onset CDs were defined as within 48 h after procedure, and late-onset CDs as after 48 h. Results A total of 2,804 patients were included for analysis. The PPI rate was 11%, of which 18% was due to late-onset CDs (>48 h). Independent predictors for late-onset CDs requiring PPI were pre-existing nonspecific intraventricular conduction delay (IVCD), pre-existing right bundle branch block (RBBB), self-expandable valves, and predilation. At least 1 of these risk factors was present in 98% of patients with late-onset CDs requiring PPI. Patients with a balloon-expandable valve without pre-dilation did not develop CDs requiring PPI after 48 h. Conclusion Safe early discharge might be feasible in patients without CDs in the first 48 h after TAVI if no risk factors for late-onset CDs leading to PPI are present.