Background and Hypothesis: Severe aortic valve stenosis is associated with LVH, which has been shown to increase all-cause mortality and lead to conduction abnormalities. Patients undergoing trans-catheter aortic valve replacement (TAVR) have an increased risk for conduction abnormalities and subsequent permanent pacemaker (PPM) implantation. We investigated an association between pre-TAVR LVH by ECG criteria and post-TAVR conduction abnormalities and need for a permanent pacemaker. This relationship has not been studied before.
Methods: A retrospective chart review was conducted in 388 consecutive TAVR patients (57.7% females, transfemoral approach in 59.3%, 77.9% with Sapien valve) without pre-TAVR pacemaker. Analyses of variation, chi-square, multi-variate, and logistic regression were used. The study was approved by the institutional IRB.
Results: Post-TAVR pacemaker was more commonly needed in patients with baseline QRS >120 msec (35 vs. 11%, p<0.003), baseline RBBB (35 vs. 20%, p<0.02), post-TAVR LBBB (39 vs. 17%, p<0.0001), or post-TAVR high-degree AV block (69 vs. 12%, p<0.0001). All 388 patients had LVH by echocardiographic criteria, but only 50% of the patients had LVH by ECG criteria. Patients with LVH by ECG criteria were more likely to develop post-TAVR LBBB (27 vs. 13%, p=0.001) or high grade AV block (26% vs. 14%, p=0.005). Overall, there was a trend for increased pacemaker need in patients with pre-TAVR LVH by ECG criteria (20% vs. 17%, p=0.385).
Conclusion: LVH by voltage criteria in TAVR patients is associated with post-TAVR LBBB and post-TAVR high degree AV blocks, which lead to post-TAVR pacemaker placement. Pre-TAVR LVH by ECG criteria may be used to identify high-risk patients in whom extended telemetry monitoring may be warranted. Additional studies investigating this important subject are needed.