Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement

Ying Tian, Deepak Padmanabhan, Christopher J. McLeod, Pei Zhang, Peilin Xiao, Gurpreet S. Sandhu, Kevin L. Greason, Rajiv Gulati, Vuyisile T. Nkomo, Charanjit S. Rihal, Lynn E. Polk, Carrie Sanvick, Xing Peng Liu, Paul A. Friedman, Yong Mei Cha

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.

Original languageEnglish (US)
Pages (from-to)e007635
JournalCirculation. Cardiovascular interventions
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2019

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Ambulatory Monitoring
Atrioventricular Block
Bundle-Branch Block
Bradycardia
Transcatheter Aortic Valve Replacement
Implantable Defibrillators
Prospective Studies

Keywords

  • aortic valve stenosis
  • atrioventricular block
  • hospitalization
  • prospective studies
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement. / Tian, Ying; Padmanabhan, Deepak; McLeod, Christopher J.; Zhang, Pei; Xiao, Peilin; Sandhu, Gurpreet S.; Greason, Kevin L.; Gulati, Rajiv; Nkomo, Vuyisile T.; Rihal, Charanjit S.; Polk, Lynn E.; Sanvick, Carrie; Liu, Xing Peng; Friedman, Paul A.; Cha, Yong Mei.

In: Circulation. Cardiovascular interventions, Vol. 12, No. 12, 01.12.2019, p. e007635.

Research output: Contribution to journalArticle

Tian, Ying ; Padmanabhan, Deepak ; McLeod, Christopher J. ; Zhang, Pei ; Xiao, Peilin ; Sandhu, Gurpreet S. ; Greason, Kevin L. ; Gulati, Rajiv ; Nkomo, Vuyisile T. ; Rihal, Charanjit S. ; Polk, Lynn E. ; Sanvick, Carrie ; Liu, Xing Peng ; Friedman, Paul A. ; Cha, Yong Mei. / Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement. In: Circulation. Cardiovascular interventions. 2019 ; Vol. 12, No. 12. pp. e007635.
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abstract = "BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5{\%}) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6{\%}) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7{\%}) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47{\%}) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14{\%} progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.",
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T1 - Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement

AU - Tian, Ying

AU - Padmanabhan, Deepak

AU - McLeod, Christopher J.

AU - Zhang, Pei

AU - Xiao, Peilin

AU - Sandhu, Gurpreet S.

AU - Greason, Kevin L.

AU - Gulati, Rajiv

AU - Nkomo, Vuyisile T.

AU - Rihal, Charanjit S.

AU - Polk, Lynn E.

AU - Sanvick, Carrie

AU - Liu, Xing Peng

AU - Friedman, Paul A.

AU - Cha, Yong Mei

PY - 2019/12/1

Y1 - 2019/12/1

N2 - BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.

AB - BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.

KW - aortic valve stenosis

KW - atrioventricular block

KW - hospitalization

KW - prospective studies

KW - transcatheter aortic valve replacement

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