The value of electrophysiologic study in decision-making regarding the need for pacemaker implantation after TAVI

Purpose The purpose of this study was to evaluate electro-physiologic study (EPS) in risk stratification of relative indications for pacemaker implantation (PMI) after transcatheter aortic valve implantation (TAVI). Methods We reviewed files of all patients who had a left bundle branch block (LBBB) and underwent EPS after TAVI between 3/2009 and 5/2015. The indications for EPS were new-onset LBBB and the presence of an old or a new-onset LBBB associated with either PR prolongation after TAVI (Delta PR >20 ms) or with slow atrial fibrillation (<100/min). Pacemakers were implanted when significant infranodal disease was demonstrated. The control group comprised of 55 consecutive patients who underwent TAVI and had an indication for an EPS per our definitions. These patients were discharged without further intervention. All patients were followed during 1 year for the composite endpoint of mortality or PMI after hospital discharge. Results Indications for EPS were new LBBB (n= 8, 30.8%), new LBBB + Delta PR > 20 ms (n= 9, 34.6%), baseline LBBB + Delta PR > 20 ms (n= 7, 26.9%) and new LBBB + slow AF <100 bpm (n= 2, 7.7%).Multilevel conduction disturbances involving the AV node (n= 19, 73.1%),the His (n=3,11.5%), and the infra-His system (n= 4, 15.4%) were found. Post discharge, there were 5 (9%) deaths and 3 (5.5%) PMI in the control group compared to none in the EPS group corresponding to event-free survival of 85 and 100%, respectively (p=0.04). Conclusions Patients with LBBB with or without Delta PR >20 ms are at a higher risk of mortality and late PMI at 1-year follow-up. EPS can be used to safely identify patients in whom a PMI is needed.