Isolated PR prolongation in patients undergoing transcatheter aortic valve implantation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: New conduction disturbances are common complications following transcatheter aortic valve implantation (TAVI). The last ESC guidelines recommended electrophysiological study (EPS) or long-term monitoring for patients with new LBBB above 150 ms or one that is associated with PR prolongation (IIa indication). For patients with preexisting conduction abnormality and further PR or QRS prolongation EPS or long-term monitoring are also recommended but with a IIb recommendation. The data regarding the prognosis and management of patients with isolated PR prolongation is limited. PURPOSE: Evaluate the need for permanant pacmaker implantation, occurance of syncope and mortality during the 1st year following Transcatheter aortic valve implantation METHODS: All patients undergoing TAVI at Shaare Zedek Medical Center were retrospectively reviewed. All patients underwent at least 1 ECG prior and daily post the procedure. Patients with isolated PR prolongation > 20 ms compared to baseline ECG were included. While patients with preexisting permanent pacemaker (PPM), complete AV block or any peri or post procedural QRS widening > 20 ms were excluded. Patient were followed for 1 year for the occurrence of syncope, PPM or death. RESULTS: Excluding patients with preprocedural PPM, 1028 patients were reviewed. Compared to baseline ECG, 124 (12%) patients had isolated PR prolongation, of whom 88 (71%) and 36 (29%) had baseline narrow and wide QRS respectively. During follow-up none of these 88 patients with baseline narrow QRS required in hospital PPM, while only 2 patients with baseline wide QRS required in hospital PPM. During 1 year follow-up, 6 patients (4.8%) died and no one had syncopal episode or need for PPM. CONCLUSION: Post TAVI, isolated new PR prolongation is not associated with an adverse outcome including syncope or progression to complete heart block and need for PPM at 1 year post the procedure. These finding may be considered when evaluating these patients post the procedure.