ROLE OF CARDIAC EVENT MONITOR IN THE DETECTION OF DELAYED HIGH-GRADE AV BLOCK AFTER NEGATIVE ELECTROPHYSIOLOGY STUDY IN PATIENTS WITH POST- TRANSCATHETER AORTIC VALVE REPLACEMENT

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Approximately 15% of transcatheter aortic valve replacement (TAVR) patients require permanent pacemaker (PPM) due to High-grade AV Block (HG AVB) following the procedure. 30-day event monitors are commonly recommended to detect delayed (> 2 days) HG AVB post-TAVR. Electrophysiology study (EPS), the following day post TAVR, has emerged as a potential risk assessment method for earlier detection of HG AVB prior to hospital discharge. Case We present two cases of high-grade atrioventricular block (HG AVB) following TAVR procedures and negative EPS. Case 1: A 94-year-old female with severe aortic stenosis underwent TAVR with a 23 mm SAPIEN Ultra valve. Transient complete heart block occurred during the procedure, followed by new-onset left bundle branch block (LBBB, QRS 142 ms). EPS showed normal AV node and HV intervals, with no infra-Hisian block. She was discharged with a 30 day event monitor. After discharge, she experienced intermittent HG AVB (including 4 to 1 block), leading to the immediate placement of a PPM on day 8 post-TAVR. Case 2: An 87-year-old female with severe aortic stenosis underwent TAVR with a 23 mm SAPIEN Ultra valve. Prior to the procedure, she had first-degree AV block (220 ms) and LBBB (QRS 152 ms) following AV valvuloplasty a few months earlier. A 30-day monitor showed no HG AVB. Following her uneventful TAVR procedure, there was no change to her baseline LBBB and 1st degree AV block. EPS post TAVR confirmed upper normal AH and HV intervals, normal AV nodal Wenckebach, and no infra-Hisian block. She was discharged with an event monitor. However, on day 24 post-TAVR, she developed sustained complete AV block, necessitating an emergent PPM placement during an ICU stay for hypoxic respiratory failure. She was discharged in stable condition. Decision-making HG AVB post TAVR remains one of the most significant complications of TAVR procedures. Our cases highlights the importance of post-discharge rhythm monitoring to detect late onset HG AVB post-TAVR after negative EPS and 24-48 hours of telemetry monitoring. Conclusion A negative EPS might not eliminate the need for 30 day event monitors to detect late onset HG AVB post TAVR, which could necessitate emergent PPM placement.

Volume

83

Issue

13

First Page

2934

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