[Aortic valve calcification evaluated by echocardiography associated with baseline conduction abnormalities as a predictor for pacemaker placement after aortic valve replacement].
BACKGROUND
Aortic valve replacement in patients with severe aortic stenosis may be complicated by complete atrioventricular block (CAVB), requiring a permanent pacemaker (PPM) implantation. Predicting this complication could help to plan the surgical.


OBJECTIVE
Determine whether electrocardiography and echocardiography are useful methods for predicting the need for PPM.


METHODS
A retrospective, observational and transversal study was performed. An echocardiography based semi-quantitative classification was implemented to graduate the extent of calcification of the aortic valve.


RESULTS
We included 95 patients; 10 of them required PPM implantation (10.52%). In the pre-surgical basal electrocardiogram we observed that 90% of patients that required PPM had conduction abnormalities as opposed to only 24.7% in the other group, p = 0.001. A 1st and 2nd degree AV block (AVB 1 and 2) was identified in 8 patients that subsequently needed PPM (80%) vs. 5 patients (5.9%), in the group that did not required it, p = 0.001.OR 41.7, IC 95% 6.5-68. We found a grade 3 calcification extent in 80% of patients who required PPM implant compared with only 17.6% of patients in the other group, p = 0.04, OR 4.8, IC 95% 0.76-29. The AVB 1 and 2 were the single predictor in multivariate analysis but the calcification 3 + AVB 1 and 2, increased sensibility.


CONCLUSIONS
In patients with aortic stenosis in whom aortic valve replacement was performed, identifying AVB 1 and 2 on the basal electrocardiogram is a useful tool in order to identify requirement of PPM. The grade 3 of calcification extent increased the sensibility of this prediction.
Departamento de Ecocardiografía. Instituto Nacional de Cardiología Ignacio Chávez.
Nydia
N
Ávila-Vanzzini
Cynthia
C
Romero-Aragonés
Juan
J
Verdejo-Paris
Gabriela
G
Meléndez-Ramírez
José Antonio
JA
Arias-Godínez
Laura Leticia
LL
Rodríguez-Chávez
Ángel
Á
Romero-Cárdenas
Francisco Javier
FJ
Roldán-Gómez
María Eugenia
ME
Ruiz-Esparza
Héctor
H
Herrera-Bello
Jorge
J
Kuri-Alfaro
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000209:etiology* / Q000628:therapy; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D012189:Retrospective Studies