title: Frequency of conduction disturbances after Edwards SAPIEN percutaneous valve implantation.
abstract: Disturbances in atrioventricular conduction and the additional need for a permanent pacemaker are recognized complications after transcatheter aortic valve replacement (TAVR). We analyzed the incidence of postprocedural conduction disorders and the need for permanent pacemaker implantation in patients undergoing TAVR with the Edwards SAPIEN valve. In 125 consecutive patients with symptomatic, severe aortic stenosis undergoing TAVR, a standard 12-lead electrocardiogram was obtained before and serially after the procedure. The cohort was divided into 2 groups with regard to the post-TAVR appearance of conduction disturbances, defined as left bundle branch block, right bundle branch block, fascicular hemiblock, atrioventricular block, and the need for a permanent pacemaker. The patients with and without conduction disturbances were compared. After TAVR, 19 patients (15.2%) met the study definition of a "new conduction defect" and 5 patients (4%) required a permanent pacemaker because of an advanced atrioventricular block. New left bundle branch block appeared in 5 patients (4%) and left anterior hemiblock in 9 (7.2%). No new right bundle branch block or left posterior hemiblock was observed. Although most baseline, echocardiographic, and procedural characteristics were equally distributed, the patients with new conduction disturbances more often had diabetes mellitus and peripheral vascular disease. Also, they more often were taking an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and the procedure was performed more often with apical access (12 [63.2%] vs 7 with femoral access [36.8%], p = 0.002). In conclusion, although the incidence of conduction disturbances was high after TAVR using the Edwards SAPIEN valve, with a significant increase in the rate of left bundle branch block and left anterior hemiblock, the need for permanent pacemaker implantation after TAVR with this valve remained low.
authors: Department of Internal Medicine, Division of Cardiology MedStar Washington Hospital Center, Washington, DC, USA.
authors: Ana
authors: A
authors: Laynez
authors: Itsik
authors: I
authors: Ben-Dor
authors: Israel M
authors: IM
authors: Barbash
authors: Camille
authors: C
authors: Hauville
authors: Gabriel
authors: G
authors: Sardi
authors: Gabriel
authors: G
authors: Maluenda
authors: Zhenyi
authors: Z
authors: Xue
authors: Lowell F
authors: LF
authors: Satler
authors: Augusto D
authors: AD
authors: Pichard
authors: Joseph
authors: J
authors: Lindsay
authors: Ron
authors: R
authors: Waksman
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000453:epidemiology* / Q000628:therapy*; D002037:Bundle-Branch Block / Q000453:epidemiology* / Q000628:therapy*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D018709:Statistics, Nonparametric; D016896:Treatment Outcome