Role of isolated PR Prolongation in conduction defects after transcatheter aortic valve implantation
T Serban, M Salis, A Papa, S Knecht, T Nestelberger, C Kaiser, G Leibundgut, B Schaer, P Krisai, F Mahfoud, M Kuehne, C Sticherling, P BadertscherAbstract
Background
Conduction system disorders are frequent complications following transcatheter aortic valve implantation (TAVI), with persistent conduction abnormalities often necessitating permanent pacemaker (PPM) implantation.
Aim
To evaluate the predictive value of isolated PR interval prolongation for PPM implantation within one year after TAVI.
Methods
We conducted a retrospective analysis of prospectively enrolled patients who underwent TAVI at our Hospital between September 2011 and March 2024. Patients with prior PPM, previous TAVI, patients in atrial fibrillation or missing ECG data were excluded. Baseline characteristics, procedural details, and serial ECGs were analyzed. The primary endpoint was PPM implantation within one year. Statistical analyses included logistic regression, Kaplan-Meier survival estimates, and Cox proportional hazards models.
Results
The cohort included 600 patients, divided into a study group (isolated PR prolongation, n=205) and a control group (no PR or QRS prolongation, n=395). At one year, PPM implantation occurred more frequently in the study group (13%) compared to controls (6.8%, p=0.01). Isolated PR prolongation was a predictor of PPM implantation (HR 2.22, 95% CI 1.25–3.93, p=0.006), particularly in patients with wide baseline QRS complexes, consistent after multivariable adjustment (aHR 1.01, CI 1.00–1.02, p= 0.013). Most patients reached maximum PR prolongation by day three post-TAVI.
Conclusion
Isolated PR prolongation after TAVI was an independent predictor of PPM implantation at one year, especially in patients with wide QRS complexes, highlighting the need for intensified monitoring in this subgroup.Graphical Abstract