Titre
Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Pagnoni, M.
Auteure/Auteur
Meier, D.
Co-première auteure/Co-premier auteur
Luca, A.
Auteure/Auteur
Fournier, S.
Auteure/Auteur
Aminfar, F.
Auteure/Auteur
Gentil, P.
Auteure/Auteur
Haddad, C.
Auteure/Auteur
Domenichini, G.
Auteure/Auteur
Lebloa, M.
Auteure/Auteur
Herrera-Siklody, C.
Auteure/Auteur
Cook, S.
Auteure/Auteur
Goy, J.J.
Auteure/Auteur
Roguelov, C.
Auteure/Auteur
Girod, G.
Auteure/Auteur
Rubimbura, V.
Auteure/Auteur
Dupré, M.
Auteure/Auteur
Eeckhout, E.
Auteure/Auteur
Pruvot, E.
Auteure/Auteur
Muller, O.
Auteure/Auteur
Pascale, P.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
2297-055X
Statut éditorial
Publié
Date de publication
2022
Volume
9
Première page
910693
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
Studies suggest that performing an electrophysiological study (EPS) may be useful to identify patients with new-onset left bundle branch block (LBBB) post-TAVR at risk of atrioventricular block. However, tools to optimize the yield of such strategy are needed. We therefore aimed to investigate whether 12-lead ECG changes post-TAVR may help identify patients with abnormal EPS findings.
Consecutive patients with new-onset LBBB post-TAVR who underwent EPS were included. PR and QRS intervals were measured on 12-lead ECG pre-TAVR and during EPS. Abnormal EPS was defined as an HV interval > 55 ms.
Among 61 patients, 28 (46%) had an HV interval > 55 ms after TAVR. Post-TAVR PR interval and ΔPR (PR-post-pre-TAVR) were significantly longer in patients with prolonged HV (PR: 188 ± 38 vs. 228 ± 34 ms, p < 0.001, ΔPR: 10 ± 30 vs. 34 ± 23 ms, p = 0.001), while no difference was found in QRS duration. PR and ΔPR intervals both effectively discriminated patients with HV > 55 ms (AUC = 0.804 and 0.769, respectively; p < 0.001). A PR > 200 ms identified patients with abnormal EPS results with a sensitivity of 89% and a negative predictive value (NPV) of 88%. ΔPR ≥ 20 ms alone provided a somewhat lower sensitivity (64%) but combining both criteria (i.e., PR > 200 ms or ΔPR ≥ 20 ms) identified almost every patients with abnormal HV (sensitivity = 96%, NPV = 95%). Selecting EPS candidate based on both criteria would avoid 1/3 of exams.
PR interval assessment may be useful to select patients with new-onset LBBB after TAVR who may benefit most from an EPS. In patients with PR ≤ 200 ms and ΔPR < 20 ms the likelihood of abnormal EPS is very low independently of QRS changes.
Consecutive patients with new-onset LBBB post-TAVR who underwent EPS were included. PR and QRS intervals were measured on 12-lead ECG pre-TAVR and during EPS. Abnormal EPS was defined as an HV interval > 55 ms.
Among 61 patients, 28 (46%) had an HV interval > 55 ms after TAVR. Post-TAVR PR interval and ΔPR (PR-post-pre-TAVR) were significantly longer in patients with prolonged HV (PR: 188 ± 38 vs. 228 ± 34 ms, p < 0.001, ΔPR: 10 ± 30 vs. 34 ± 23 ms, p = 0.001), while no difference was found in QRS duration. PR and ΔPR intervals both effectively discriminated patients with HV > 55 ms (AUC = 0.804 and 0.769, respectively; p < 0.001). A PR > 200 ms identified patients with abnormal EPS results with a sensitivity of 89% and a negative predictive value (NPV) of 88%. ΔPR ≥ 20 ms alone provided a somewhat lower sensitivity (64%) but combining both criteria (i.e., PR > 200 ms or ΔPR ≥ 20 ms) identified almost every patients with abnormal HV (sensitivity = 96%, NPV = 95%). Selecting EPS candidate based on both criteria would avoid 1/3 of exams.
PR interval assessment may be useful to select patients with new-onset LBBB after TAVR who may benefit most from an EPS. In patients with PR ≤ 200 ms and ΔPR < 20 ms the likelihood of abnormal EPS is very low independently of QRS changes.
PID Serval
serval:BIB_BC29EB9F987B
PMID
Open Access
Oui
Date de création
2022-09-26T11:34:21.301Z
Date de création dans IRIS
2025-05-20T22:46:14Z
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article.pdf
Version du manuscrit
published
Taille
725.53 KB
Format
Adobe PDF
PID Serval
serval:BIB_BC29EB9F987B.P004
URN
urn:nbn:ch:serval-BIB_BC29EB9F987B9
Somme de contrôle
(MD5):94c50b121686f4a4d0d7dc0b218efe27