High Burden of Sensing Changes in Periprocedural TAVR Patients With Pre-Existing CIEDs Presents A Unique Challenge
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.
Madanat L, Shah K, Haines D, Mehta N. High burden of sensing changes in periprocedural TAVR patients with pre-existing CIEDs presents a unique challenge. Circulation 2021 Nov 16; 144(Suppl 1):A13691.