title: Atrioventricular conduction after transcatheter aortic valve implantation and surgical aortic valve replacement.
abstract: BACKGROUND
  Atrioventricular conduction abnormalities (AVCA) may complicate transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). The aim of this study was to prospectively evaluate AVCA after TAVI and SAVR.
  
  
  RESULTS
  Among 50 patients undergoing TAVI and 25 patients undergoing SAVR a continuous 7-day Holter electrocardiogram (ECG) was recorded after the procedure. ECGs during TAVI and 12-lead ECGs before and 1 and 7 days after TAVI and SAVR were analyzed. At baseline, TAVI patients were older (mean 82.1 vs 75.4, P < 0.001), had a longer PR interval (median 200 milliseconds vs 175 milliseconds, P = 0.004) and broader QRS width (median 100 milliseconds vs 80 milliseconds, P = 0.007) than SAVR patients. New AVCA were observed among 29 TAVI patients (58%), mostly new left bundle branch block (76%). Predilatation induced new AVCA in 14 TAVI patients (28%). New AVCA resolved within 24 hours in 15 TAVI patients (30%), and persisted in 14 TAVI (28%) and 3 SAVR patients (12%, P = 0.12). Among patients with persistent QRS width <120 milliseconds during the first 24 hours after TAVI, QRS width remained stable during the remainder of the observation period. During Holter monitoring complete AV block was observed in 4 TAVI patients (8%) and 3 SAVR patients (12%; P = 0.68).
  
  
  CONCLUSIONS
  Almost half of AVCA during TAVI are induced by predilatation, but half of them resolve within 24 hours. Persistent AVCA are more frequently observed after TAVI than SAVR. If QRS width is below 120 milliseconds the first day after TAVI, the risk of late AVCA seems low.
authors.affiliation: Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Flavio
authors.initials: F
authors.lastname: Scarcia
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Etienne
authors.initials: E
authors.lastname: Delacrétaz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome