title: Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with Edwards SAPIEN prosthesis.
abstract: OBJECTIVE
  Permanent pacemaker requirement is a known complication after transcatheter aortic valve implantation (TAVI). The aim of the present study was to analyze the effects of Edwards SAPIEN prosthesis implantation on atrioventricular conduction.
  
  
  METHODS
  The study included 28 patients who underwent TAVI due to severe aortic valve stenosis. An electrophysiological study was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after Edwards SAPIEN prosthesis implantation.
  
  
  RESULTS
  His-ventricle interval was significantly prolonged postprocedure (55.9 ± 11.5 ms) vs preprocedure (47.3 ± 7.8 ms) (P<.001). The antegrade Wenckebach point was observed to be significantly prolonged postprocedure (354.4 ± 41.3 ms) vs preprocedure (333.7 ± 45.4 ms) (P=.001). Despite atrial-His interval prolongation, it was not statistically significant. After the procedure, we observed significant conduction disturbances in 3 patients (10.7%). These conduction problems recovered before discharge. One of the patients (3.6%) with right bundle branch block + left anterior fascicular block required permanent pacemaker implantation. At postprocedure electrocardiogram, QRS duration increased, QRS axis shifted to the left, and both of the values became normal before discharge. The patient's echocardiographic and clinical parameters were improved during follow-up.
  
  
  CONCLUSIONS
  The effect of Edwards SAPIEN on the conduction system was mostly infranodal and temporary. The physical properties of the Edwards SAPIEN prosthesis may explain this observation. This complication may be lessened if the frame height characteristics can be improved.
authors.affiliation: 1Istanbul Mehmet Akif Ersoy Thoracic – Cardiovascular Surgery Training and Research Hospital Cardiology Department, Istanbul, Turkey. drmg23@gmail.com
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Eksik
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Ozgur
authors.initials: O
authors.lastname: Surgit
authors.forename: Aydin
authors.initials: A
authors.lastname: Yildirim
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Huseyin
authors.initials: H
authors.lastname: Aksu
authors.forename: Selahattin
authors.initials: S
authors.lastname: Turen
authors.forename: Fazih
authors.initials: F
authors.lastname: Uzun
authors.forename: Hulusi
authors.initials: H
authors.lastname: Satılmısoglu
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Erol
authors.forename: Ihsan
authors.initials: I
authors.lastname: Bakir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery; D001283:Atrioventricular Node / Q000503:physiopathology*; D063126:Balloon Valvuloplasty / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome