Prospective Observational Study on the Accuracy of Predictors of Permanent Pacemaker Secondary to High-Grade Atrioventricular Conduction Block After TAVI (CONDUCT-TAVI).

Authors

Karan Rao, Bernard Chan, Kunwardeep Bhatia, Natasha Saad, Alexandra Baer, David Whalley, Christopher Choong, Peter Hansen, Ravinay Bhindi

Published in

Circulation. Cardiovascular interventions. Pages e015446. Sep 15, 2025. Epub Sep 15, 2025.

Abstract

The incidence of permanent pacemaker implantation (PPMI) due to high-grade atrioventricular block after transcatheter aortic valve implantation (TAVI) is 10% to 15% at 1-year, and current prediction algorithms remain unreliable.
CONDUCT-TAVI is a prospective observational study of 200 patients undergoing TAVI across 2 centers. Baseline demographic, anatomic and procedural characteristics were recorded, followed by targeted electrophysiology studies and continuous rhythm monitoring using implantable loop recorders for 1 year. The primary outcome was PPMI secondary to high-grade atrioventricular block, and secondary outcomes included early (≤48 hours) and late (>48 hours) PPMI, new-onset persistent left bundle branch block, and new-onset atrial fibrillation. Predictors were assessed using multivariable logistic regression.
PPMI due to high-grade atrioventricular block occurred in 21.0% of patients (early PPMI: 13.5%, late PPMI: 7.5%). Key predictors included preexisting right bundle branch block (adjusted odds ratio, 5.45 [95% CI, 1.67-17.84]; P=0.005), ΔHV interval >10 ms (adjusted odds ratio, 3.62 [95% CI, 1.23-10.67]; P=0.020), and pre-TAVI rapid atrial pacing-induced atrioventricular Wenckebach (adjusted odds ratio, 3.70 [95% CI, 1.37-9.98]; P=0.010). The CONDUCT-TAVI score combined these variables with high predictive accuracy (area under the curve=0.794) and negative predictive value (98%). New-onset persistent left bundle branch block (>24 hours) was observed in 19.1%, and new-onset atrial fibrillation in 21.7% at 1 year.
The incidence of conduction abnormalities remains high after TAVI, and after factoring in anatomic, procedural, and electrophysiological factors, a baseline right bundle branch block and electrophysiology study-derived measures of AV conduction were the most significant predictors of PPMI. The CONDUCT-TAVI score incorporates these findings to help implanters stratify low-risk patients and tailor follow-up care.

PMID:
40948125
Bibliographic data and abstract were imported from PubMed on 15 Sep 2025.

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