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.