Prospective Evaluation of a Simplified Discharge and Temporary Pacing Algorithm After Transcatheter Aortic Valve Replacement.

Background: The increasing patient volume undergoing transcatheter aortic valve replacement (TAVR) necessitates procedural simplification and short admissions without compromising safety. The objective of this study was to prospectively evaluate a novel electrocardiogram (ECG)-based algorithm for discharge and the use of temporary pacemakers (TPMs) in pacemaker-naïve TAVR patients. Methods: Patients were stratified into next-day discharge, second-day discharge, or third-day discharge groups based on preprocedural right bundle branch block and immediate postprocedural ECG changes. Prophylactic TPMs were restricted to patients with pre-existing right bundle branch block or a PQ interval >250 ​ms. Results: Among 664 patients, the mean age was 80.8 ​± ​5.7 years, 46.0% were females, and 69.8% were discharged as planned or earlier. Self-expandable valves and balloon-expandable valves were used in 28.0 and 72.0%, respectively. The shorter the planned observation, the larger the fraction of discharge delays caused by nonconduction issues (next-day discharge 68.9%, second-day discharge 43.6%, and third-day discharge 10.2%, respectively, Conclusions: A discharge algorithm based on preprocedure and immediate postprocedure ECG in PPM-naïve patients undergoing TAVR, including a high threshold for TPM insertion, enables postimplant discharge planning in most cases and significantly reduces the use of TPMs without compromising safety during hospitalization or after discharge.