title: High-degree atrioventricular block in patients with preexisting bundle branch block or bundle branch block occurring during transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has become the standard therapy for high-risk and non-operable patients with severe aortic stenosis. However, the procedure involves several adverse effects, such as rhythm and conduction disturbances. Patients with postprocedural left bundle branch block may have an increased mortality risk, whereas patients with preprocedural right bundle branch block display a higher rate of postinterventional bradyarrhythmias.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the occurrence of high-degree atrioventricular block (AVB) in patients with preexisting bundle branch block (BBB) or BBB occurring during TAVI.
  
  
  METHODS
  In this prospective single-center study, 50 consecutive patients undergoing TAVI with the Medtronic CoreValve Revalving System were included. Of these patients, 17 with preexisting BBB or BBB occurring during TAVI received a primary prophylactic permanent DDD pacemaker, programmed to the SafeR-mode and featuring dual-channel event counters as well as stored intracardiac electrograms. Pacemaker readouts and intracardiac electrograms were analyzed for the occurrence of high-degree AVB.
  
  
  RESULTS
  Ten of 17 patients (58.8%) with preexisting BBB or BBB occurring during TAVI developed episodes of high-degree AVB that were immediately terminated due to switch into DDD backup pacing. In 5 of the cases (29.4%), the first documented episode of high-degree AVB occurred after hospital discharge. Mean follow-up period was 578.1 ± 294.9 days.
  
  
  CONCLUSIONS
  Development of high-degree AVB is a common complication in patients with preexisting BBB or BBB occurring during TAVI. Accordingly, intensified monitoring might be reasonable, especially in patients treated with the self-expandable Medtronic CoreValve Revalving System.
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria. Electronic address: florian_egger@gmx.net.
authors.forename: Florian
authors.initials: F
authors.lastname: Egger
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Nürnberg
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Miklos
authors.initials: M
authors.lastname: Rohla
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Weiss
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Unger
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Smetana
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Geppert
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Susanne C
authors.initials: SC
authors.lastname: Gruber
authors.affiliation: Department of Anaesthesiology, Wilhelminenhospital, Vienna, Austria.
authors.forename: Anton
authors.initials: A
authors.lastname: Bambazek
authors.affiliation: Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Falkensammer
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
authors.forename: Ferdinand R
authors.initials: FR
authors.lastname: Waldenberger
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Freynhofer
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D010138:Pacemaker, Artificial; D064266:Preexisting Condition Coverage; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Atrioventricular block; Bundle branch block; Pacemaker; Transcatheter aortic valve implantation