Predictors for new-onset complete heart block after transcatheter aortic valve implantation.
OBJECTIVE
The aim of this study was to identify risk factors for new-onset atrioventricular (AV) block requiring pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI).


BACKGROUND
High-grade AV block and consecutive PM implantation are frequent complications following TAVI.


METHODS
For logistic regression analysis, we included 159 patients (mean age: 81 +/- 6 years, EuroSCORE: 22 +/- 13%) who underwent TAVI (n = 116 transfemoral, n = 4 via subclavian artery, n = 37 transapical, n = 2 transaortic) between June 2007 and January 2009 and who had no previously implanted PM.


RESULTS
Thirty-five patients (22%) developed new-onset post-operative AV block with the need of PM implantation. Logistic regression revealed a 2-fold increased risk for new-onset AV block in patients in whom a large valve is implanted in a small annulus (32% pacemaker implantations, odds ratio [OR]: 2.378, p = NS), a 4-fold increased risk with the implantation of the CoreValve (Medtronic, Minneapolis, Minnesota) versus the Edwards Sapien valve (Edwards Lifesciences, Irvine, California) (27% pacemaker implantations, OR: 3.781, p = NS), and a 5-fold increased risk for patients who exhibit an AV block episode instantly during the implantation procedure (49% pacemaker implantations, OR: 4.819, p = 0.001). Pre-existing ECG alterations were not identified as risk factors for AV block after transcatheter aortic valve implantation.


CONCLUSIONS
We assume that conduction tissue impairment is provoked by mechanical compression with large prostheses in smaller annuli or in the larger area of the CoreValve covering the outflow tract and may appear instantly during the implantation procedure. Continuous post-operative electrocardiogram monitoring should be performed for at least 3 days in all patients after TAVI procedures and until discharge in patients with increased risk for this complication.
Bleiziffer
Sabine
S
Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany. bleiziffer@dhm.mhn.de
Ruge
Hendrik
H
Hörer
Jürgen
J
Hutter
Andrea
A
Geisbüsch
Sarah
S
Brockmann
Gernot
G
Mazzitelli
Domenico
D
Bauernschmitt
Robert
R
Lange
Rüdiger
R
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome