Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters.

Autor:	Pagnoni M; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Meier D; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Luca A; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Fournier S; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.; Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Aminfar F; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Gentil P; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Haddad C; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.; Arrhythmias Unit, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France., Domenichini G; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Lebloa M; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Herrera-Siklody C; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Cook S; Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland.; Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland., Goy JJ; Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland.; Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland., Roguelov C; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Girod G; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Rubimbura V; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Dupré M; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Eeckhout E; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Pruvot E; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Muller O; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland., Pascale P; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Sep 06; Vol. 9, pp. 910693. Date of Electronic Publication: 2022 Sep 06 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.910693
Abstrakt:	Background: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Pagnoni, Meier, Luca, Fournier, Aminfar, Gentil, Haddad, Domenichini, Lebloa, Herrera-Siklody, Cook, Goy, Roguelov, Girod, Rubimbura, Dupré, Eeckhout, Pruvot, Muller and Pascale.)
Databáze:	MEDLINE
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