58 Implementing the jacc consensus statement pathways for management of conduction disturbances post -TAVI – the effect on inpatient length of stay

Background Transcatheter Aortic Valve Implantations (TAVIs) are associated with a need for Permanent Pacemaker (PPM) insertion with a frequency between 2.3% - 36.1% at 30 days post procedure. Although the indication for PPM is often apparent at the time of TAVI, many patients develop indications for PPM in a delayed manner following TAVI, and can have fatal outcomes when they present with delayed high degree AV block, leading to uncertainty around duration of monitoring following TAVI. In 2019, the JACC Consensus Statement was published to help guide physicians in this regard. Methods We reviewed patients who underwent TAVI in our centre who had complete follow up data between 2018–2019. We categorised them according to the groups suggested in the consensus document. We assessed their subsequent PPM implantation rate at 30 days, and reviewed their length of inpatient admission. Results 56 patients (37 males) without prior PPM underwent TAVI in our centre in the study period. There were 30 patients in group 1 (no ECG changes without pre-existing right bundle branch block (RBBB)), all alive at 30 days, of whom 2 (6.7%) underwent a PPM within 30 days of TAVI. Their median length of stay was 3 days (2–6). There were 5 patients in group 2 (no new ECG changes, with pre existing RBBB); of these none required a PPM at 30 days, with a median LOS of 8 days (4.5–8). 5 patients in group 3 (New ECG changes in patients with pre-existing conduction disease) had a median length of stay of 5 days (3–17), 4 of whom required PPM by 30 days. 7 patients in group 4 (new left bundle branch block (LBBB)) median length of stay was 5 days (3–7), of whom 1 (14.2%) required a PPM. 2 patients in group 5, of whom both required PPM, and median length of stay was 4 days (3.5–4.5). There was only 1 patient (in group 2) who was discharged prior to the recommended length of monitoring as per the Consensus statement. The risk categorisation is effective for determining high risk patients for monitoring. Conclusion Implementation of the JACC consensus statement does not significantly lengthen the duration of inpatient stay in our institution. However, it effectively stratifies risk of PPM in patients following TAVI, and could be helpful in determining length of rhythm monitoring.