Impact of QRS Duration on Decision of Early Removal of Pacing Catheter After Transcatheter Aortic Valve Replacement With CoreValve Device

Abstract

The purpose of this study was to determine the predictability of QRS duration (QRSd) for temporary pacing catheter removal in patients implanted with CoreValve. Permanent pacemaker implantation is a known complication after transcatheter aortic valve replacement (TAVI) with CoreValve. Although post-TAVI QRSd is highly predictive for advanced atrioventricular block (AVB), management of delayed AVB after TAVI remains unclear. We conducted a multicentric, prospective study of 156 consecutive patients who underwent TAVI with CoreValve between December 2010 and January 2013. Patients who had acute AVB after TAVI were excluded (n = 25). We classified the patients into 2 groups based on the post-TAVI QRSd. Patients with QRSd <120 ms were assigned to early pacing catheter removal group (n = 34), and patients with QRSd ≥120 ms were assigned to keep the pacing catheter with monitoring group (n = 97). No patient required permanent pacemaker implantation in the early pacing catheter removal group, whereas 38 patients with QRSd ≥120 ms had a delayed AVB (QRSd <120 ms vs ≥120 ms: 0% vs 39%, p = 0.0001). The intensive care unit stay length, 30-day mortality, and incidence of complications were lower in the early catheter removal group. Post-TAVI QRSd allows patient selection for early removal of pacing catheter in patients implanted with CoreValve.