title: Ventricular arrhythmias in aortic valve stenosis before and after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is a therapeutic treatment for patients with severe aortic stenosis (AS) at high surgical risk. Although the procedure is associated with a reduction in total mortality, there are no data regarding changing in the incidence of premature ventricular contractions (PVCs) and ventricular arrhythmias (VAs) after TAVI. The aim of this study was to assess the incidence of VAs before and after TAVI.
  
  
  RESULTS
  We enrolled 237 patients who underwent TAVI at our centre. Ninety-one patients were excluded for the following reasons: presence of prior permanent pacemaker (PPM) (n = 20), new PPM implant after TAVI (n = 48), death during the follow-up period (n = 16), and lost at follow-up (n = 7). Finally, 146 patients were included in our analysis. The presence of VAs was evaluated in all patients recording a 24 h Holter monitoring before the procedure and after 1 and 12 months. Ventricular arrhythmias were classified according to a modified Lown grading system. Before the procedure, isolates PVCs (grade 1-2 of Lown grading system) were present in 34.9% of patients (n = 51). Complex PVCs (grade 3-4a-4b of Lown grading system) were present in 48.6% of the population (multifocal PVCs in 32 patients, 21.9%; pairs in 25 patients, 17.1%; ventricular tachycardia in 14 patients, 9.6%). One month after the procedure, we observed statistically significant incidence decrease of arrhythmias of grade 3 (from 21.9 to 17.1%) and grade 4 (pairs from 17.1 to 12.3%; ventricular tachycardia from 9.6 to 4.8%). After 12 months, there was a further significant reduction in the frequency and severity of PVCs. In particular, 45.8% of patients had isolates PVCs (<30 in all given hours of monitoring in 45 patients, 30.8%; higher than 30 in any hour of monitoring in 22 patients, 15%) while the frequency of complex arrhythmias was reduced to 16.4% (multifocal PVCs in 13 patients, 9%; couplets 8 patients, 5.5% and ventricular tachycardia in 3 patients, 2.0%). The difference was statistically significant (P < 0.01).
  
  
  CONCLUSIONS
  This study indicates that VAs are common in patients with AS. We observed a significant decrease in the incidence and severity of PVCs since the first month after TAVI. Furthermore, after 1 year follow-up there was a further and significant reduction in the frequency of complex PVCs. This may be related to the benefits determined by valve replacement on left ventricular function.
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy donatella.tempio@gmail.com.
authors.forename: Donatella
authors.initials: D
authors.lastname: Tempio
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Giusi Paola
authors.initials: GP
authors.lastname: Pruiti
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Conti
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Salvo Andrea
authors.initials: SA
authors.lastname: Romano
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Tavano
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Liotta
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Grazia
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Calvi
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality*; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000401:mortality*
keywords: Lown grading system; Transcatheter aortic valve implantation; Ventricular arrhythmias