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Challenges in Clinical Electrocardiography
September 2018

Isorhythmic Atrioventricular Dissociation and the Purloined P Wave After Transcatheter Aortic Valve Replacement

Author Affiliations
  • 1Division of Cardiovascular Medicine, University of California, Davis, Medical Center, Sacramento
JAMA Intern Med. 2018;178(9):1264-1265. doi:10.1001/jamainternmed.2018.2868

Conduction abnormalities are a recognized complication of transcatheter aortic valve replacement (TAVR).1 Previous studies have shown a 4% to 18% incidence of left bundle branch block (LBBB) and a 7% frequency of complete atrioventricular (AV) block after TAVR.2,3 The incidence of LBBB increases with preexisting left anterior hemiblock, larger prosthesis, and deeper implantation of the latter, whereas the incidence of complete AV block is associated with new LBBB, preexisting right bundle branch block, and prosthetic valve type.1,4 The occurrence of marked conduction abnormalities with clinically significant bradycardia may be an indication for a permanent pacemaker. The frequency of permanent pacemaker placement after TAVR has been reported to be as high as 25%.1

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