title: Transient and persistent conduction abnormalities following transcatheter aortic valve replacement with the Edwards-Sapien prosthesis: a comparison between antegrade vs. retrograde approaches.
abstract: BACKGROUND
  Electrocardiographic conduction abnormalities following transcatheter aortic valve replacement (TAVR) with the Edwards-Sapien valve (ESV) are not uncommon and may be transient. We sought to examine the clinical time-course of conduction abnormalities after TAVR with ESV and determine risk factors for persistent abnormalities.
  
  
  METHODS
  In this single-center prospective study, 116 consecutive patients underwent implantation of the ESV after approval by the Food and Drug Administration (FDA). Demographic, clinical, and intra-procedural variables were collected in a registry, including ECGs before, immediately after, and at discharge from hospital. Conduction abnormalities were analyzed including PR interval lengthening, QRS widening, left bundle branch block (LBBB), and high-grade AV block.
  
  
  RESULTS
  There were 92 patients included in the analysis. A total of 41 new conduction abnormalities were observed in 31 (34 %) patients: 7 new PR prolongation, 14 QRS widening, 14 new LBBB, and 5 high-grade AV block requiring permanent pacemaker. Of the 41 new CAs, 11 (27 %) were transient; of the transient abnormalities, 9 (82 %) resolved within 24 h of the index procedure. Chronic kidney disease was a risk factor for the development of a persistent abnormality and for need for PPM. Antegrade approach was associated with the development of persistent LBBB and persistent QRS widening.
  
  
  CONCLUSIONS
  A significant proportion of conduction abnormalities after ESV implantation improved prior to discharge from the hospital, usually within 24 h. CKD is associated with persistence of abnormalities and with need for PPM. Antegrade approach increases risk for new intraventricular conduction delays, including LBBB.
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA. sjsager@gmail.com.|Cardiac Electrophysiology, Chicago Cardiology Institute, 7035 W. North Ave, Oak Park, IL, 60302, USA. sjsager@gmail.com.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Sager
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Abdulla A
authors.initials: AA
authors.lastname: Damluji
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Sachil
authors.initials: S
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: O'Neill
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Williams
authors.affiliation: Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality*; D002908:Chronic Disease; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005431:Florida / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D011474:Prosthesis Design; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*
keywords: AV conduction; Pacemaker; Transcatheter aortic valve replacement