AUTHOR=Pagnoni Mattia , Meier David , Luca Adrian , Fournier Stephane , Aminfar Farhang , Gentil Pascale , Haddad Christelle , Domenichini Giulia , Le Bloa Mathieu , Herrera-Siklody Claudia , Cook Stephane , Goy Jean-Jacques , Roguelov Christan , Girod Grégoire , Rubimbura Vladimir , Dupré Marion , Eeckhout Eric , Pruvot Etienne , Muller Olivier , Pascale Patrizio 

TITLE=Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.910693

DOI=10.3389/fcvm.2022.910693

ISSN=2297-055X

ABSTRACT=Background: Studies suggest that performing an electrophysiological study (EPS) may be useful to identify patients with new-onset left bundle branch block (LBBB) post-TAVR at risk of atrioventricular block. However, tools to optimize the yield of such strategy are needed. We therefore aimed to investigate whether 12-lead ECG changes post-TAVR may help identify patients with abnormal EPS findings.
Methods: Consecutive patients with new-onset LBBB post-TAVR who underwent EPS were included. PR and QRS intervals were measured on 12-lead ECG pre-TAVR and during EPS. Abnormal EPS was defined as an HV interval >55ms.
Results: Among 61 patients, 28 (46%) had an HV interval >55ms after TAVR. Post-TAVR PR interval and ΔPR (PR-post–pre-TAVR) were significantly longer in patients with prolonged HV (PR: 188±38 vs. 228±34ms, p<0.001, ΔPR: 10±30 vs. 34±23ms, p=0.001), while no difference was found in QRS duration. PR and ΔPR intervals both effectively discriminated patients with HV>55ms (AUC=0.804 and 0.769, respectively; p<0.001).
A PR>200ms identified patients with abnormal EPS results with a sensitivity of 89% and a negative predictive value (NPV) of 88%. ΔPR≥20ms alone provided a somewhat lower sensitivity (64%) but combining both criteria (ie PR>200ms or ΔPR≥20ms) identified almost every patients with abnormal HV (sensitivity=96%, NPV=95%). Selecting EPS candidate based on both criteria would avoid 1/3 of exams. 
Conclusion: PR interval assessment may be useful to select patients with new-onset LBBB after TAVR who may benefit most from an EPS. In patients with PR≤200ms and ΔPR<20ms the likelihood of abnormal EPS is very low independently of QRS changes.