Demographic and Electrocardiographic Predictors
Age and sex were found to be significant in identifying patients at
greater risk, as was diabetes. Interestingly other comorbidities such as
hypertension, COPD, prior PCI, or prior aortic valve procedure were not.
Conduction defects are common during deployment of valves due to the
close anatomic proximity of the aortic valve to the AV node as well as
to the bundle of His. While many of these defects are transient, they
can lead to heart block because the practice of keeping a temporary
transvenous pacemaker post-procedure still exists. However, there is
limited literature on how long a temporary pacemaker should be left in
place before a decision is made for PPMI. Our report recognized the
patients with underlying conduction defects of RBBB (identified as the
most reliable predictor), LAFB, baseline, and post-procedure AVB
as those with the greatest risk for needing PPMI. Particular focus
should be given to underlying conduction defects while devising
guidelines for the timing of pacemaker insertion.