Thirty-Day High-Grade Aortic Valve Block Post-Transcatheter Aortic Valve Replacement in Patients Discharged on Heart Rhythm Monitor

TL;DR

This study examines the risk and incidence of high-grade aortic valve block after a heart procedure called TAVR, using a monitoring protocol to identify patients at risk.

Contribution

A 3-group risk stratification algorithm for predicting high-grade aortic valve block post-TAVR with high negative predictive value is validated.

Findings

7.8% of patients developed high-grade aortic valve block, with 68% being asymptomatic.

80% of high-grade aortic valve block events occurred within the first 2 weeks post-TAVR.

Male sex, baseline right bundle branch block, and post-TAVR QRS >150 ms were significant risk factors.

Abstract

Conduction disease is an important and common complication post-transcatheter aortic valve replacement (TAVR). Previously, we developed a conduction disease risk stratification and management protocol post-TAVR. This study aims to evaluate high-grade aortic valve block (HAVB) incidence and risk factors in a large cohort undergoing ambulatory cardiac monitoring post-TAVR according to conduction risk grouping.

This single-center, retrospective study evaluated all patients discharged on ambulatory cardiac monitoring between 2016 and 2021 and stratified them into 3 groups based on electrocardiogram predictors of HAVB risk (group 1 [low], group 2 [intermediate], and group 3 [high]). HAVB was defined as ≥2 consecutive nonconducted P waves in sinus rhythm or bradycardia <50 beats/minute with a fixed rate for atrial fibrillation/flutter. Descriptive statistics were used to show the incidence and timeline, while logistic regression was utilized to evaluate predictors of HAVB.

Five hundred twenty-eight patients were included (median age 80 years [74-85]; 43.8% female). Forty-one patients (7.8%) developed HAVB during ambulatory monitoring (68% were asymptomatic). Over a median follow-up of 2 years (1.3-2.7), the overall mortality rate was 15.0% (30-day mortality rate of 0.57%, n = 3). Risk factors for HAVB were male sex (odds ratio [OR] = 2.46, p = 0.02, 95% CI = 1.21-5.43), baseline right bundle branch block (OR = 2.80, p = 0.01, 95% CI = 1.17-6.19), and post-TAVR QRS >150 ​ms (OR = 2.16, p = 0.03, 95% CI = 1.01-4.40). The negative predictive value for patients in groups 1 and 2 for 30-day HAVB was 95.0 and 93.8%, respectively.

The risk of 30-day HAVB post-TAVR on ambulatory monitoring post-TAVR varies according to post-TAVR electrocardiogram findings, and a 3-group algorithm effectively identifies groups with a low negative predictive value for HAVB.

•The timeline and symptoms of patients discharged on ambulatory monitoring post-transcatheter aortic valve replacement are not clear.•The incidence of high-grade aortic valve block was 7.8% (68% asymptomatic).•Eighty percent of high-grade aortic valve block events occurred in the first 2 ​weeks.•These findings could help establish a national consensus on post-transcatheter aortic valve replacement conduction disease management.

The timeline and symptoms of patients discharged on ambulatory monitoring post-transcatheter aortic valve replacement are not clear.

The incidence of high-grade aortic valve block was 7.8% (68% asymptomatic).

Eighty percent of high-grade aortic valve block events occurred in the first 2 ​weeks.

These findings could help establish a national consensus on post-transcatheter aortic valve replacement conduction disease management.

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