Background:Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR.Methods:This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up.Results:Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days.Conclusions:In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.

中文翻译：

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30天连续门诊监测的实用性，用于确定经导管主动脉瓣置换后房室传导阻滞延迟发生的患者。

背景：需要永久起搏器（PPM）和经导管主动脉瓣置换（TAVR）程序相关的传导系统中的机械损伤是常见的并发症。这项研究的目的是使用动态监护仪BodyGuardian评估TAVR后房室传导阻滞（AVB）的晚期发生。方法：这项前瞻性研究评估了2016年6月至2017年8月在明尼苏达州罗彻斯特市梅奥诊所接受过TAVR的365例患者。在出院前接受TAVR后因心动过缓而接受PPM的患者被视为PPM组。那些不需要PPM的人接受了BodyGuardian系统（BodyGuardian组）进行了30天的连续监控。主要终点为30天随访时的Mobitz II或三度房室传导阻滞（II / III AVB）。结果：365名患者中，排除了在TAVR之前使用PPM或植入式心脏复律除颤器的74名患者和参加其他研究的94名患者。在参与研究的197位患者中，有70位（35.5％）接受了PPM，127位接受了BodyGuardian，然后才被医院解散。127名（8.6％）BodyGuardian组中有11名在TAVR后30天内需要PPM来治疗症状性心动过缓。总共197例患者中有33例（16.7％）发展为II / III型AVB（出院前24例，出院后9例）。34例患者已存在右束支传导阻滞。其中，有16家（47％）开发了II / III AVB。在53例TAVR后出现新的左束支传导阻滞的患者中，有14％的患者在30天内发展为II / III型AVB。