Patients With a Normal EKG after TAVI Rarely Require a New Pacemaker Interview with:
Dr. Stefan Toggweiler, MD
Heart Center, Luzerner Kantonsspital
Lucerne, Switzerland What is the background for this study?

Response: Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of aortic stenosis in inoperable and high-risk patients. It is well known that TAVR is associated with acute and delayed occurrence of conduction disorders. Namely, delayed high-degree atrioventrcular block is a feared complication. Thus, patients are usually monitored by telemetry for a few days, but there is currently no consensus on the duration of telemetry. In this study, we evaluated how the postprocedural ECG determines the need for permanent pacemaker implantation in patients undergoing TAVR. What are the main findings?

Response: We evaluated 1064 patients undergoing TAVR with a balloon-expandable or a self-expanding valve at 3 centers in Switzerland. The main finding of this study was that patients with a normal post-procedural ECG did not develop high-degree atrioventricular block and did not require implantation of a permanent pacemaker. Accordingly, such patients do not require telemetry monitoring. In the absence of other complications, these patients may be candidates for early discharge. What should readers take away from your report?

Response: These patients are at risk for delayed high-degree atrioventricular block. Therefore, such patients should be monitored until the ECG remains stable for at least 48 hours. What recommendations do you have for future research as a result of this study?

Response: The field of TAVR is evolving very fast. Now, we have very promising next-generation self-expanding valves that have already received CE mark. Further research is required to determine if our findings hold true for these newer valves. Is there anything else you would like to add?

Response: Optimization of the patient pathway and reduction of costs are important. However, patient safety remains the most important goal. In Lucerne, we do not monitor all our patients with telemetry. However, as long as the patient remains hospitalized, we do record a daily 12 lead ECG to detect arrhythmias such as bradycardia, atrial fibrillation, or other ECG changes. Thank you for your contribution to the community.


Toggweiler S, Stortecky S, Holy E, et al. The Electrocardiogram After Transcatheter Aortic Valve Replacement Determines the Risk for Post-Procedural High-Degree AV Block and the Need for Telemetry Monitoring. J Am Coll Cardiol Intv. 2016;9(12):1269-1276. doi:10.1016/j.jcin.2016.03.024.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 25, 2016 by Marie Benz MD FAAD