title: Ventricular conduction defects after transcatheter aortic valve implantation: a single-institute analysis.
abstract: Patients with aortic stenosis tend to develop ventricular conduction problems, which are known adverse events following transcatheter aortic valve implantation (TAVI). Changes in ventricular conduction status after TAVI were analyzed in 195 consecutive patients from a single institute registered in FRANCE2 between February 2010 and June 2012. Among the 195 patients, 29 had a prior pacemaker implantation (+PM) and 6 had acute catastrophic hemodynamics that made a full electrocardiogram (ECG) unavailable. Among the remaining 160, PM was newly required in 28 (17.5%, PM+) but not in 132 (PM-), which included 21 (13.1%) who developed new left bundle branch block (BBB), 12 (7.5%) had right BBB, and 99 (61.9%) had no change. While PM requirement had no correlation with preoperative factors, there was significant association with the development of right BBB with Edwards Sapien/XT (P = 0.003), and new left BBB (P = 0.012) and complete heart block requiring PM with CoreValve (22.6% vs. Edwards Sapien/XT, 7.4%, P = 0.016). Whereas postoperative survival regarding PM status (+PM, PM+, PM-), vascular access, valve size or type showed no difference, delayed heart block (n = 12, Day 2 or later) was associated with poor survival (P = 0.038) compared with the remaining PM+ patients with earlier onset (n = 16, Day 0 or 1). As a result, PM+ patients (n = 28) had significantly longer intensive care unit (ICU) stay and hospitalization than PM- or +PM patients. The results suggest that ventricular conduction problems requiring PM occurred more frequently after TAVI (17.5%) than with usual surgical replacement. Nonetheless, conduction problems failed to influence postoperative survival for up to 3 years on average with use of PM, but therefore did increase medical costs.
authors.affiliation: Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Akira T
authors.initials: AT
authors.lastname: Kawaguchi
authors.affiliation: Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Cosimo
authors.initials: C
authors.lastname: D'Allessandro
authors.affiliation: Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Department d'Imagerie et de Radiologie Interventionelle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cluzel
authors.affiliation: Department d'Anesthésie Reanimation, Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Ralouka
authors.initials: R
authors.lastname: Makri
authors.affiliation: Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D002037:Bundle-Branch Block / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Permanent pacemaker implantation; Single-institute experience; Transcatheter aortic valve implantation; Ventricular conduction defect