Clin Res Cardiol (2022).

Electrocardiographic changes after TAVR using contemporary valve systems
J. Lueg1, L. Morell1, B. Juri2, A. Janiszewski1, M. Hajduczenia2, P. Hennig2, A. Erbay2, S. M. Niehues3, H. Dreger1, D. Leistner2, U. Landmesser2, K. Stangl1, V. Tscholl2
1CC11: Med. Klinik m. S. Kardiologie und Angiologie, Charité - Universitätsmedizin Berlin, Berlin; 2CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; 3Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin;


Detection and adequate therapy of new-onset conduction disturbances after transcatheter aortic valve replacement (TAVR) remain one of the most frequent complications in modern therapy of aortic stenosis. Recent studies reported pacemaker implantation rates between 4 to 27.7% and new onset of left bundle branch block (LBBB) up to 19.2% depending on the valve system used. The aim of this study was to analyze ECG changes and pacemaker implantation rates in a large study population using contemporary valves.

Methods and Results

From January 2019 till December 2020, 1056 patients underwent TAVR at Charité Universitätsmedizin, Berlin (mean age 82 ± 6.1 years, 45% female). In this retrospective analysis, we reviewed 933 ECGs before and 1015 ECGs within 48 hours after TAVR. Mean left ventricular ejection fraction (LVEF) was 54.7 ± 11%, mean STS Score was 4.5 ± 3.6%. 51% of the implanted valves were self-expandable (11.4% Evolut R/PRO, 42.5% Portico), 46.1% balloon-expandable (Edwards Sapien 3).

Following current guidelines, we analyzed six different groups regarding ECG changes after TAVR: Patients developing new first-degree atrioventricular block (AV block I°, n = 80; 11.8%), new LBBB (n = 230; 23.3%), new PR-time > 240ms (n = 29; 2.9%), prolongation of PR-time by >20ms (n = 181; 21.5%), prolongation of QRS duration by >20ms (n = 299; 32.9%) and patients with pacemaker implantation (n = 123; 15.6%).

After multivariate analysis, new first-degree AV Block was associated with a larger valve size (OR 1.18, CI 95% 1.01-1.3; p=0.02). PR-time >240ms after TAVR was associated with pre-existing AV block I° (OR 1.1, CI 95% 1.05-1.1; p<0.001). New LBBB after TAVR was more frequently observed after the implantation of Portico valve (OR 2.1; CI 95% 1.2-3.4; p<0.004) and with deeper implantation (OR 1.1, CI 95% 1.04-1.2; p<0.003). Independent risk factor for a prolongation of QRS duration >20ms was the implantation depth (OR 1.1, CI 95% 1.03-1.22; p=0.008). Prolongation of QRS and PR-time by >20ms was less frequent after implantation of a balloon-expandable valve (OR 0.4 CI 95% 0.22-0.75; p=0.004 and OR 0.54 CI 95% 0.28-1.015; p=0.04). Permanent pacemaker implantation was associated with the implantation of a Portico valve (p=0.02). However, after multivariate analysis, only pre-existing first-degree AV block (OR 1.8, CI 95% 1.1-3.2; p=0.02), pre-existing right bundle branch block (RBBB, OR 5.1, CI 95% 2.7-9.4; p<0.01) and implantation depth (OR 1.1, CI 95% 1.01-1.28; p=0.02) remained independent risk factors for pacemaker implantation after TAVR.


In this large, contemporary study population we observed a relevant increase in new LBBB and unspecific prolongation of the QRS-duration post TAVR. New onset LBBB was associated with the implantation of a Portico valve. In contrast, implantation of a balloon-expandable valve was associated with the lowest risk for changes in PQ and QRS time. 15.6% of patients needed post-procedural pacemaker implantation after TAVR. As shown with older valve generations, pre-existing RBBB, first-degree AV block and the implantation depth remain the most important risk factors.