High Burden of Sensing Changes in Periprocedural TAVR Patients With Pre-Existing CIEDs Presents A Unique Challenge

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Introduction: The data on the management of patients undergoing transcatheter aortic valve replacement (TAVR) with pre-existing cardiac implantable electronic devices (CIED) is scarce.

Objective: We describe the R wave sensing changes following TAVR in a patient with CIED and describe CIED behavior peri procedurally in a high volume center over 8 years.

Results: A 64 year old male patient with a history of non-ischemic cardiomyopathy and a secondary prevention dual-chamber ICD presented for generator change. Six months prior, he underwent TAVR (29mm ES S3). Post TAVR, he developed a new RBBB. Device interrogation revealed a significant drop in sensed R waves from 9mV to 1.5mV which temporally correlated with TAVR (Figure 1). Pacing thresholds and impedance were stable. Chest x-rays showed stable lead position. Given drop in R wave sensing, successful defibrillation threshold testing was performed with generator change. Of the 115 patients with pre-existing CIEDs undergoing TAVR between 2012-2020, 23.5% (27 patients) showed changes in sensing (mean 3.0±2.5mV) peri procedurally with minimal change in impedance or threshold with no correlation with QRS changes.

Conclusions: To our knowledge, this is the 1st reported case of a change in sensed R waves due to conduction disturbance following TAVR. We hypothesize this occurred due to a change in the activation wavefront sensed by the right ventricular lead following the development of new RBBB. Up to a quarter of patients have sensing fluctuations in our experience. Consideration of pre and post device interrogation with TAVR could be of value.




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