Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance

Nimrod Perel, Oholi Tovia-Brodie, Asher Schnur, Moshe Rav Acha, Nir Levi, Yogev Cohen, Danny Dvir, Michael Glikson, Yoav Michowitz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Conduction abnormalities post-transcatheter aortic valve implantation (TAVI) are common. Post-TAVI PR prolongation was mainly studied as an adjunct to new-onset bundle branch block. The net effect of isolated PR prolongation (IPRP) without post-TAVI QRS changes is not well known. The aim of this study was to define the incidence and clinical significance of post-TAVI IPRP Methods A total of 1108 consecutive TAVI patients were reviewed. Patients with IPRP were compared with patients without post- and results TAVI electrocardiogram (ECG) changes. Clinical outcomes included permanent pacemaker implantation (PPI) and overall mortality. A total of 146 patients with IPRP were compared with 290 patients without post-TAVI ECG changes. At 1 year follow-up, 4 (2.7%) and 7 (2.4%) patients underwent PPI (P = 0.838) and 10 (6.8%) and 25 (8.6%) died (P = 0.521), from the study and control groups, respectively. No patient with IPRP and narrow QRS underwent PPI during 1 year post-TAVI, and all death events were non-cardiac except one unknown cause. Permanent pacemaker implantation rates among patients with IPRP and wide QRS were higher (n = 4, 12.1%), compared with patients with wide QRS without post-TAVI ECG change (n = 3, 4%) however not reaching statistical significance (P = 0.126). Multivariate Cox proportional hazards model demonstrated that in patients with narrow QRS, neither PR prolongation nor baseline or maximal PR intervals was associated with the combined endpoint of PPI and mortality. However, in patients with wide QRS, baseline PR intervals and QRS width, but not PR prolongation were associated with the combined outcome Conclusion Post-TAVI IPRP in patients with narrow QRS is not associated with adverse outcome. This finding may translate clinically into a more permissive approach to these patients.

Original languageEnglish
Article number26
JournalEuropace
Volume26
Issue number1
DOIs
StatePublished - 1 Jan 2024
Externally publishedYes

Keywords

  • Keywords Transcatheter aortic valve implantation PR interval Conduction abnormality Pacemaker

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