Relationship between ECG parameters and electrophysiological study in post-TAVI de novo left bundle branch block

Abstract Background The measurement of the HV interval in post-TAVI has a determining place in the most recent recommendations. However, its value, in addition to the post-TAVI ECG, remains debated. To describe the correlation in post-TAVI ECG and HV in case of de novo left bundle branch block and his correlation to PR interval prolongation. Methods Prospective, open-label study with 12 months follow-up. From June 2015 to November 2018, TAVR recipients were included at 10 centers in the French Multicenter LBBB-TAVR study. 183 TAVR recipients (64% self-expanding valve) had a new-onset LBBB after TAVR persisting for more than 24 hours. HV interval was assessed by intracardiac EPS and compared to ECG parameter on the day of EPS. Results 1631 ECGs were recovered and double-read. On the day of EPS the mean PR was 224±51 ms, the mean QRS duration was 148±18 ms. The PR increases after TAVI by a maximum of 60±43 ms to reach a mean maximum PR of 252±55 ms. It increases progressively in the post-procedure period from 25±37ms, until the 4th day (44±32ms, p<0.001). The mean HV interval delay was 62±14 ms, the AH was 140±63 ms. The HV interval was weakly correlated with the duration of the PR interval (0.19), the AH interval had a correlation of 0.72. In logistic regression, PR ≥ 240 ms and QRS ≥ 150 ms were independent predictor of HV prolongation (HR 7.6 [3.0 - 12.2], p=0.001 and 5.9 [1.6 - 10.3], p=0.007). The rate of conduction disturbance at 1 year in case of prolonged HV, QRS ≥ 150 ms and PR ≥ 240 ms was 57% vs. 27% if HV < 70 ms (p<0.001). Conclusions In post-TAVI de novo left bundle branch block, PR interval prolongation is a dynamic, transient process driven by an alteration of atrioventricular node. The HV interval prolongation is poorly correlated to post-TAVI PR prolongation and LBBB duration.Correlation between ECG and EP studyConduction disorders after TAVR