Abstract/Description
Abstract:
Background: Transcatheter Aortic Valve Replacement (TAVR) is the standard of care for many patients with severe aortic stenosis who cannot undergo surgical intervention. However, conduction disturbances remain a frequent complication, particularly with self-expanding valves. This often leads to permanent pacemaker implantation (PPI). At Sentara Heart Hospital, atrial pacing at 140 bpm is standard practice during TAVR to assess AV conduction.
Objective: This study aims to evaluate whether preserved 1:1 atrioventricular (AV) conduction during routine atrial pacing at 140 bpm after self-expanding TAVR predicts a low likelihood of requiring PPI, thus yielding a high negative predictive value (NPV).
Methods: We will prospectively analyze patients undergoing TAVR with self-expanding valves from January to December 2026. Patients will be stratified into three cohorts based on conduction response to pacing: (1) preserved 1:1 conduction, (2) Wenckebach or first-degree AV block, and (3) persistent high-grade block. Outcomes will include in-hospital and 1-year PPI rates, mortality, and conduction-related complications. Machine learning models will also be developed to explore predictive capability using EMR and procedural data.
Results (Anticipated): We hypothesize that in patients undergoing TAVR with a self-expanding valve, maintenance of 1:1 AV conduction during standard atrial pacing at 140 bpm is associated with a low likelihood of permanent pacemaker implantation. This would establish post-TAVR atrial pacing as a suitable test to yield a high negative predictive value.
Conclusion: This study may help refine post-TAVR management, reduce unnecessary PPI, hospital days, and cost burden in patients receiving self-expanding valves.
Faculty Advisor/Mentor
Matthew R Summers
Faculty Advisor/Mentor Email
mrsumme1@sentara.com
Faculty Advisor/Mentor Department
Sentara Heart Hospital
College/School/Affiliation
Eastern Virginia Medical School (EVMS)
Included in
Cardiology Commons, Circulatory and Respiratory Physiology Commons, Medical Biotechnology Commons, Medical Pathology Commons
Using Atrial Pacing Trials After TAVR to Assess Conduction Abnormalities and Predict Need for Pacemaker Implantation
Abstract:
Background: Transcatheter Aortic Valve Replacement (TAVR) is the standard of care for many patients with severe aortic stenosis who cannot undergo surgical intervention. However, conduction disturbances remain a frequent complication, particularly with self-expanding valves. This often leads to permanent pacemaker implantation (PPI). At Sentara Heart Hospital, atrial pacing at 140 bpm is standard practice during TAVR to assess AV conduction.
Objective: This study aims to evaluate whether preserved 1:1 atrioventricular (AV) conduction during routine atrial pacing at 140 bpm after self-expanding TAVR predicts a low likelihood of requiring PPI, thus yielding a high negative predictive value (NPV).
Methods: We will prospectively analyze patients undergoing TAVR with self-expanding valves from January to December 2026. Patients will be stratified into three cohorts based on conduction response to pacing: (1) preserved 1:1 conduction, (2) Wenckebach or first-degree AV block, and (3) persistent high-grade block. Outcomes will include in-hospital and 1-year PPI rates, mortality, and conduction-related complications. Machine learning models will also be developed to explore predictive capability using EMR and procedural data.
Results (Anticipated): We hypothesize that in patients undergoing TAVR with a self-expanding valve, maintenance of 1:1 AV conduction during standard atrial pacing at 140 bpm is associated with a low likelihood of permanent pacemaker implantation. This would establish post-TAVR atrial pacing as a suitable test to yield a high negative predictive value.
Conclusion: This study may help refine post-TAVR management, reduce unnecessary PPI, hospital days, and cost burden in patients receiving self-expanding valves.