Predictive role of ventricular repolarization parameters for the occurrence of complete heart block in patients undergoing transcatheter aortic valve implantation.

Background: We investigated the role of ventricular repolarization parameters to predict complete atrioventricular block in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: A total of 150 patients undergoing TAVI due to severe aortic stenosis were included in this retrospective cohort study. Patients were assigned in two groups based on the presence (n: 49) or absence (n: 101) of complete atrioventricular block after TAVI. Ventricular repolarization intervals (QT, QTc, JT, JTc, TP-E), indices (QT dispersion), and ratios (TP-E/QT, TP-E/QTc, TP-E/JTc) were measured.

Results: Electrocardiographic repolarization parameters such as Tp-e interval: 74.2 ± 5.1 versus 59.2 ± 6.1 ms, p < .001; QTc interval: 397.6 ± 3.4 versus 368.1 ± 7.8 ms, p < .001; JTc interval: 317.4 ± 11.3 versus 291.1 ± 6.7 ms, p < .001; Tp-e/QT ratio: 0.28 ± 0.04 versus 0.20 ± 0.04, p < .001; Tp-e/QTc ratio: 0.29 ± 0.04 versus 0.19 ± 0.03, p < .001; Tp-e/JT ratio: 0.32 ± 0.03 versus 0.23 ± 0.03, p < .001; Tp-e/JTc ratio: 0.30 ± 0.02 versus 0.2 ± 0.03, p < .001; and QT dispersion: 34.4 ± 3.0 versus 17.8 ± 3.6 ms, p < .01 were significantly higher in post-TAVI permanent pacemaker group. In a univariate regression analysis, pulmonary artery pressure, heart rate, coronary artery disease, Tp-e/QTc, Tp-e/JTc, and PR interval were significantly associated with complete heart block. Tp-e/JTc (OR 0.373, p = .067) and PR interval (OR 0.898, p = .079) were found to be independent predictors of these type of arrhythmias in a multivariate analysis. But it is not statistically significant.

Conclusion: Our results suggest that repolarization parameters may play a role in predicting complete atrioventricular block. Tp-e/JTc was found to be potential independent risk marker for this setting.