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Prediction of Delayed Atrioventricular Block and Pacemaker Implantation After Transcatheter Aortic Valve Replacement With CoreValve
Accepted Manuscript Title: Prediction of Delayed Atrioventricular Block and Pacemaker Implantation after Trans-Catheter Aortic Valve Replacement with Core Valve Author: Akihiro Kobayashi, Naoki Misumida PII: DOI: Reference:
S0002-9149(17)31693-4 https://doi.org/10.1016/j.amjcard.2017.09.037 AJC 22980
To appear in:
The American Journal of Cardiology
Please cite this article as: Akihiro Kobayashi, Naoki Misumida, Prediction of Delayed Atrioventricular Block and Pacemaker Implantation after Trans-Catheter Aortic Valve Replacement with Core Valve, The American Journal of Cardiology (2017), https://doi.org/10.1016/j.amjcard.2017.09.037. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Prediction of Delayed Atrioventricular Block and Pacemaker Implantation after Trans-catheter Aortic Valve Replacement with Core Valve Dear Editor, Takahashi et al recently reported that prolonged QRS duration more than 120 ms on post-intervention ECG was associated with delayed atrioventricular (AV) block and pacemaker implantation (PMI) in patients who underwent trans-catheter aortic valve replacement (TAVR) with Core Valve1. We read this article with great interest. In Takahashi’s study, a large majority of the patients (74.0%, 97 out of 131) had prolonged QRS duration, thus the clinical utility of this marker alone to identify high-risk patients for delayed AV block may be limited. In addition to QRS duration, pre-intervention prolonged first-degree AV block has also been reported to be a predictor for PMI in patients who underwent TAVR with Core Valve2. However, in Takahashi’s study, post-intervention PR interval was not evaluated. We wonder if incorporating both QRS duration and PR interval (either pre- or post-intervention) may help us to further risk-stratify patients who are at increased risk for delayed AV block and PMI compared to QRS duration alone. Lastly, it should be pointed out the rate of PMI in Takahashi’s study was 40.4% (63 out of 156; including immediate and delayed PMI) in the overall cohort, which was higher than the previously reported rate 28%2. Acknowledgements None
Declaration of interest No conflicts of interests to declare
Akihiro Kobayashi M.D. Phoenix, Arizona Naoki Misumida M.D. Lexington, Kentucky
Page 1 of 2
Date of submission: 09/18/2017
References 1.
Takahashi M, Mouillet G, Deballon R, Sudre A, Lellouche N, Lim P, et al. Impact of QRS Duration on Decision of Early Removal of Pacing Catheter After Transcatheter Aortic Valve Replacement With CoreValve Device. Am J Cardiol 2017;120:838–843.
2.
Siontis GCM, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol 2014;64:129–140.
Page 2 of 2
S0002-9149(17)31693-4 https://doi.org/10.1016/j.amjcard.2017.09.037 AJC 22980
To appear in:
The American Journal of Cardiology
Please cite this article as: Akihiro Kobayashi, Naoki Misumida, Prediction of Delayed Atrioventricular Block and Pacemaker Implantation after Trans-Catheter Aortic Valve Replacement with Core Valve, The American Journal of Cardiology (2017), https://doi.org/10.1016/j.amjcard.2017.09.037. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title: Prediction of Delayed Atrioventricular Block and Pacemaker Implantation after Trans-catheter Aortic Valve Replacement with Core Valve Dear Editor, Takahashi et al recently reported that prolonged QRS duration more than 120 ms on post-intervention ECG was associated with delayed atrioventricular (AV) block and pacemaker implantation (PMI) in patients who underwent trans-catheter aortic valve replacement (TAVR) with Core Valve1. We read this article with great interest. In Takahashi’s study, a large majority of the patients (74.0%, 97 out of 131) had prolonged QRS duration, thus the clinical utility of this marker alone to identify high-risk patients for delayed AV block may be limited. In addition to QRS duration, pre-intervention prolonged first-degree AV block has also been reported to be a predictor for PMI in patients who underwent TAVR with Core Valve2. However, in Takahashi’s study, post-intervention PR interval was not evaluated. We wonder if incorporating both QRS duration and PR interval (either pre- or post-intervention) may help us to further risk-stratify patients who are at increased risk for delayed AV block and PMI compared to QRS duration alone. Lastly, it should be pointed out the rate of PMI in Takahashi’s study was 40.4% (63 out of 156; including immediate and delayed PMI) in the overall cohort, which was higher than the previously reported rate 28%2. Acknowledgements None
Declaration of interest No conflicts of interests to declare
Akihiro Kobayashi M.D. Phoenix, Arizona Naoki Misumida M.D. Lexington, Kentucky
Page 1 of 2
Date of submission: 09/18/2017
References 1.
Takahashi M, Mouillet G, Deballon R, Sudre A, Lellouche N, Lim P, et al. Impact of QRS Duration on Decision of Early Removal of Pacing Catheter After Transcatheter Aortic Valve Replacement With CoreValve Device. Am J Cardiol 2017;120:838–843.
2.
Siontis GCM, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol 2014;64:129–140.
Page 2 of 2