Transcatheter Aortic Valve Replacement (TAVR) Effects on Cardiac Conduction System
Inclusion criteria -all patients undergoing elective TAVR Exclusion criteria -patients with permanent implanted pacemakers or ICDs prior to TAVR
Record standard 12-lead ECG prior to procedure.
Place standard electrode catheter via a venous sheath prior to TAVR
Initially place the catheter in a proximal position with a large atrial electrogram and proximal His electrogram.
Record baseline His bundle electrogram. Record baseline AH and HV intervals.
Pace the atrium starting at a cycle length 100 ms shorter than the sinus cycle length, progressively reducing the paced cycle length in 20 ms decrements after 3 seconds pacing at each cycle length, while continuously monitoring arterial blood pressure, to A-V block.
Advance the distal electrodes while maintaining recording of a His bundle electrogram to a position where stable right ventricular pacing is secured. Record the RV pacing threshold.
If a stable right ventricular pacing position together with stable His bundle electrogram cannot be achieved, a second venous temporary pacing wire will be placed.
Record presence or absence of retrograde conduction during RV pacing at 4 times pacing threshold.
Ensure stable continuous His bundle electrogram recording while the aortic valve prosthesis is deployed.
Use the distal electrodes for rapid ventricular pacing at 4 times threshold during deployment of the valve prosthesis.
After the prosthesis has been deployed and is deemed stable, just prior to removing the RV catheter, record a final HBE (AH, HBE, SCL) and again pull back catheter to enable atrial capture with proximal electrodes - pace as above to AV block: start starting at a cycle length 100 ms shorter than the sinus cycle length, progressively reducing the paced cycle length in 20 ms decrements after 3 seconds pacing at each cycle length while monitoring continuous arterial blood pressure to A-V block.
Record 12-lead ECG after completion of the procedure and daily thereafter until hospital discharge.
Standard telemetry monitoring post procedure while hospitalized.
Upon hospital discharge place a standard continuous ambulatory ECG monitor for 2 weeks in patients that do not have a pacemaker implanted.