title: Impact of a new conduction defect after transcatheter aortic valve implantation on left ventricular function.
abstract: OBJECTIVE
  This study sought to evaluate the impact of new conduction defects after transcatheter aortic valve implantation (TAVI) on the evolution of left ventricular (LV) function during 1-year follow-up.
  
  
  BACKGROUND
  New left bundle branch block (LBBB) or need for permanent pacing due to atrioventricular (AV) block are frequent after TAVI.
  
  
  METHODS
  A total of 90 consecutive patients treated with TAVI and who had 12-month echocardiographic follow-up were included in the study. In 39 patients, a new conduction defect (new LBBB or need for permanent pacemaker activity.) persisted 1 month after TAVI. In 51 patients, no persistent new conduction defect was observed. Two-dimensional echocardiography using parasternal short-axis, apical 4-chamber, and apical 2-chamber views was performed before TAVI and at 1-year follow-up to determine LV volumes and ejection fraction based on Simpson's rule. Speckle-tracking echocardiography was applied using standard LV short-axis images to assess the effect of new conduction defects on time-to-peak radial strain of different LV segments as a parameter of LV dyssynchrony.
  
  
  RESULTS
  New conduction defects resulted in marked heterogeneity in time-to-peak strain between the 6 analyzed short-axis segments. During 1-year follow-up after TAVI, there was a significant increase in left ventricular ejection fraction (LVEF) in patients without new LBBB (53 ± 11% pre TAVI to 59 ± 10% at follow-up; p < 0.001), whereas there was no change in LVEF in patients with a new conduction defect (52 ± 11% pre TAVI to 51 ± 12% at follow-up, p = 0.740). Change in LV end-systolic volume was also significantly different between patient groups (-1.0 ± 14.2 vs. -11.2 ± 15.7 ml, p = 0.042). New conduction defect and LVEF at baseline were independent predictors of reduced LVEF at 12-month follow-up after TAVI.
  
  
  CONCLUSIONS
  LVEF improves after TAVI for treatment of severe aortic stenosis in patients without new conduction defects. In patients with a new conduction defect after TAVI, there is no improvement in LVEF at follow-up.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Aachen, Germany. rhoffmann@ukaachen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Ralf
authors.initials: R
authors.lastname: Herpertz
authors.forename: Sara
authors.initials: S
authors.lastname: Lotfipour
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Aktug
authors.forename: Kathrin
authors.initials: K
authors.lastname: Brehmer
authors.forename: Walter
authors.initials: W
authors.lastname: Lehmacher
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfi
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000209:etiology* / Q000503:physiopathology*; D002037:Bundle-Branch Block / Q000209:etiology* / Q000503:physiopathology*; D006328:Cardiac Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016277:Ventricular Function, Left