Valvular heart disease
Predictors and Course of High-Degree Atrioventricular Block After Transcatheter Aortic Valve Implantation Using the CoreValve Revalving system

https://doi.org/10.1016/j.amjcard.2011.07.020Get rights and content

Transcatheter aortic valve implantation (TAVI) is a novel treatment for high risk or inoperable patients with symptomatic severe aortic stenosis. However, significant atrioventricular (AV) conduction system abnormalities requiring permanent pacemaker (PPM) implantation might complicate this procedure. We used best subsets logistic regression analysis to identify the independent predictors for the development of high-degree AV block (HDAVB) among 70 patients who underwent TAVI at 3 referral centers in Israel from 2008 to 2010. The mean age of the study patients was 83 ± 4.6 years. Of the 70 patients, 28 (40%) developed AV conduction abnormalities requiring PPM implantation within 14 days (median 2) of the procedure. The indications for PPM implantation were HDAVB (n = 25), new-onset left bundle branch block with PR prolongation (n = 2), and slow atrial fibrillation (n = 1). Best subsets logistic regression analysis showed that, among the 15 prespecified clinical, electrocardiographic, and echocardiographic candidate risk factors, only right bundle branch block at baseline (odds ratio 43; p = 0.002) and deep valve implantation (<6 mm from the lower edge of the noncoronary cusp to the ventricular end of the prosthesis, odds ratio 22; p <0.001) were independently associated with the development of periprocedural HDAVB. At 3 months of follow-up, HDAVB was still present in 40% of the patients who received PPM implantation for this indication. In conclusion, 40% of the patients who undergo CoreValve TAVI require PPM implantation after the procedure, with most cases (36%) associated with the development of postprocedural HDAVB. Baseline conduction abnormalities (right bundle branch block) and deep valve implantation (>6 mm) independently predicted the development of HDAVB and the need for PPM implantation after CoreValve TAVI.

Section snippets

Methods

The study population included consecutive patients with aortic stenosis in whom a CoreValve Revalving System was implanted at 3 referral medical centers in Israel from 2008 to 2010. The patients were referred for TAVI after a careful evaluation and discussion by a local heart team, with a consensus that surgical aortic valve replacement would be associated with either high or prohibitive risk. The baseline clinical, electrocardiographic, echocardiographic, and angiographic parameters were

Results

Of the 70 study patients, 25 (36%) developed HDAVB during or after the procedure. All patients who developed HDAVB underwent PPM implantation. In addition, 3 patients underwent PPM implantation because of the development of left bundle branch block with PR prolongation (n = 2) or slow atrial fibrillation (n = 1). Thus, 28 patients (40%) required PPM implantation after the procedure. The baseline clinical, electrocardiographic, echocardiographic, and procedural characteristics, stratified by the

Discussion

The results of the present study have confirmed previous data regarding the relatively high rate of the development of major AV conduction abnormalities followed by PPM implantation among patients who undergo TAVI using the CoreValve system. We have shown that HDAVB developed in 35% of study patients, and the need for PPM implantation developed in 40% of study patients within 30 days of the procedure. Furthermore, in most patients who developed HDAVB (96%), it occurred within the first 5 days

Cited by (0)

View full text