Abstract 13908: Prevalence and Implications of Junctional Rhythm During Transcatheter Aortic Valve Replacement

Introduction: Cardiac conduction abnormalities are among the most frequent complications of transcatheter aortic valve replacement (TAVR). A small case series has raised the possibility that junctional rhythm (JR) following TAVR may be associated with poor outcomes. However, the prevalence and implications of JR during TAVR have not been systematically studied. Methods: We retrospectively reviewed intra-procedural continuous 6-lead telemetry of 300 consecutive patients undergoing TAVR between April 2015 and April 2019 to identify JR that occurred after deploying the valve . Forty-two patients with pre-existing permanent pacemaker (PPM) were excluded. JR was defined as regular rhythm without P waves but with QRS morphology that was identical to baseline. Results: A total of 258 patients fulfilled the inclusion criteria (mean age of 77.5±8.5 years and 99% men). During TAVR, 79 (30.6%) patients developed new JR. The mean ventricular rate was 74.6±31.0 bpm. Patients who developed JR had similar baseline characteristics compared to those without JR (Table). After TAVR, 57 (22.1%) patients required PPM for complete atrioventricular block. There was a trend for a higher rate of PPM implantation in patients with rapid JR (39%) vs. slow JR (26%) vs. no JR (19.0%, p=0.10). In logistic regression analysis, patients who had a rapid JR (rate >100 bpm) were 2.71 times (95% CI 0.98-7.52, p=0.055) more likely to require PPM than those without JR. Conclusions: Junctional rhythm after deploying the valve is common in TAVR. There was a trend for higher PPM implantation risk among patients who developed rapid JR. Further investigation of these observations in larger cohorts is needed.