Sex-specific differences in infranodal conduction properties in patients undergoing transcatheter aortic valve replacement

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Electrophysiological (EP) testing has been proposed for risk stratification of patients with left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). A uniform cut-off of 70ms for the His-Ventricular (HV) interval has been proposed to trigger pacemaker implantation. However, sex-specific periprocedural data regarding infranodal conduction properties are lacking. PURPOSE: We aimed to compare the HV interval in men and women undergoing TAVR. METHODS: We analyzed consecutive prospectively included patients undergoing TAVR between June 2020 and June 2021 at a tertiary referral center. EP testing was performed in all patients pre- and post-valve deployment and in the case of LBBB additionally for a third time the following day. RESULTS: 127 patients were included (81 ± 7 years, 46% female). Median HV interval pre-valve deployment was 43 [37-50] ms vs 46 [42-53] ms in women and men, respectively (p=0.016). Nine patients underwent peri-procedural pacemaker (PM) implantation for third-degree AV-block. The median HV interval post-valve deployment was 54 [42-59] ms in women and 56 [51-61] ms in men (p=0.038). The median HV interval the day following TAVR in patients with LBBB was 45 [41-49] ms in women and 50 [48-62] ms in men (p=0.048). An HV interval ≥ 55 ms and ≥70 ms was present the day following TAVR in seven patients (24%, two females) and three patients (10%, one female). (Figure) CONCLUSION: Women have shorter HV intervals pre-and post-valve-deployment as well as the day following TAVR compared to men. Further studies evaluating sex-specific cut-offs for the HV interval are warranted. [Figure: see text]