{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T12:10:19Z","timestamp":1750939819438,"version":"3.40.5"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>New and persistent left bundle branch block (NP\u2010LBBB) following Transcatheter Aortic Valve Replacement (TAVR) is an ongoing concern with incidence ranging from as low as 4% to up to 65% (varying for different types of valves). Such patients are at risk of developing high\u2010grade atrioventricular block (HAVB) warranting permanent pacemaker (PPM) implantation. However, currently, there are no consensus guidelines or large prospective studies to risk stratify these patients for safer discharge after TAVR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To provide insight from a single center study on using modified electrophysiology (EP) study to risk stratify post\u2010TAVR patients to outpatient monitoring for low\u2010risk versus pacemaker implantation for high\u2010risk patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Between June 2020 and March 2023, all patients who underwent a TAVR procedure (324 patients) at our institution were screened for development of NP\u2010LBBB post\u2010operatively. Out of 26 patients who developed NP\u2010LBBB, after a pre\u2010specified period of observation, 18 patients were deemed eligible for a modified EP study to assess His\u2010Ventricular (HV) interval. 11 out of 18 patients (61.1%) had normal HV interval (HV\u00a0&lt;\u00a055\u00a0ms). Three out of 18 patients (16.7%) had HV prolongation (55\u00a0ms\u00a0&lt;\u00a0HV\u00a0&lt;\u00a070\u00a0ms) without significant HV prolongation (defined as an increase in HV interval\u00a0&gt;\u00a030%) with intra\u2010procedural procainamide challenge. Four out of 18 patients (22.2%) had significant HV prolongation (HV\u00a0&gt;\u00a070\u00a0ms) warranting PPM implantation based on a multidisciplinary approach and shared decision\u2010making with the patients. Total of 50% of patients discharged with PPM (two out of four patients) were noted to be pacemaker dependent based on serial device interrogations. All patients who did not receive PPM were discharged with ambulatory monitoring with 30\u2010day event monitor and did not develop HAVB on serial follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Normal HV interval up to 55\u00a0ms on modified EP study after TAVR and development of NP\u2010LBBB can be utilized as a threshold for risk stratification to facilitate safe discharge. The optimal upper limit of HV interval threshold remains unclear in determining appropriate candidacy for PPM.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14784","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T17:33:08Z","timestamp":1689010388000},"page":"1099-1108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Electrophysiological evaluation following development of new and persistent left bundle branch block after transcatheter aortic valve replacement: A single center pilot study"],"prefix":"10.1111","volume":"46","author":[{"given":"Hiren","family":"Patel","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Saint Louis University Saint Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medicine Saint Louis University Saint 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