title: Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR.
abstract: BACKGROUND
  Left ventricular conduction disturbances (VCD) with or without need for pacemaker (PM) implantation are common after transcatheter aortic valve replacement (TAVR). Its effect on patients' functional recovery after TAVR is unclear.
  
  
  RESULTS
  212 patients (Age 80.8 ± 6.4 years, logEuroscore 28.95 ± 17.37 %) underwent TAVR with the self-expanding CoreValve prosthesis and completed 9-month follow-up (FU). After TAVR 125 (59 %) patients were diagnosed with VCD. This group consists of 41 (19 %) patients with a new PM after TAVR, 33 (16 %) patients with PM prior TAVR and markedly increased ventricular stimulation rate, 48 (23 %) patients with new LBBB post-TAVR and three (1 %) patients with LBBB prior TAVR. After FU, the presence of VCD alone was associated with worse recovery of left ventricular ejection fraction (LVEF) (VCD: LVEFbaseline 51.7 ± 18.2 %, LVEFFU 53.9 ± 13.0 %; p = 0.8; noVCD: LVEFbaseline 53.8 ± 12.9 %, LVEFFU 63.4 ± 10.1 %; p < 0.01) but had no impact on functional outcomes after TAVR (p > 0.05). Especially patients with VCD caused by permanent RV pacing showed worse functional outcomes presenting with higher functional NYHA classes (p < 0.05), and higher NT-proBNP levels (p < 0.05). 20.4 % of patients with need for PM after TAVR remained in NYHA class ≥3, as compared to 5 % of patients without PM (VCD but no PM: 4.7 %, p < 0.001; noVCD: 5.3 %, p < 0.001). VCD with or without need for PM had no impact on survival after FU.
  
  
  CONCLUSIONS
  The occurrence of VCD after TAVR is common and associated with unfavorable left ventricular functional recovery. However, only the combination of VCD with permanent right ventricular pacing has adverse impact on heart failure-related symptoms after TAVR.
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany. Marcel.Weber@ukb.uni-bonn.de.
authors.forename: Marcel
authors.identifier: http://orcid.org/0000-0003-4100-9522
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Brüggemann
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Momcilovic
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schiller
authors.affiliation: Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.affiliation: Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str.25, 53105, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000401:mortality*; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D015995:Prevalence; D020127:Recovery of Function; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*
keywords: Aortic stenosis; Left ventricular recovery; Pacemaker; TAVI; TAVR; Valvular heart disease; Ventricular conduction disturbances