Steroid therapy and conduction disturbances after transcatheter aortic valve implantation.
BACKGROUND
Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI.


RESULTS
From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10). We compared the rate of occurrence of new conduction disturbances and pacemaker implantation between TAVI patients with (n=39) and without (n=285) steroid treatment, using Cox logistic regression estimates and proportional hazards models. The overall occurrence of new conduction defects and the need for new pacemaker implantation were similar among steroid and non-steroid-treated patients (38.4% vs 37.5% and 25.6% vs 25.3%, respectively). New conduction disturbances were more prevalent in patients treated with CoreValve prosthesis, low implantation, and smaller aortic annulus diameter (P<.001, P<.001, and P=.006, respectively). Thirty-day mortality and complication rates were similar between the groups.


CONCLUSIONS
Although safe, steroid treatment prior to TAVI failed to reduce the incidence of new conduction defects and the need for pacemaker implantation.
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel. oferhavakuk@yahoo.com.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. oferhavakuk@yahoo.com.
Ofer
O
Havakuk
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Maayan
M
Konigstein
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Eyal
E
Ben Assa
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Yaron
Y
Arbel
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Yigal
Y
Abramowitz
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Amir
A
Halkin
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Samuel
S
Bazan
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Haim
H
Shmilovich
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Gad
G
Keren
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Ariel
A
Finkelstein
Interventional Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Shmuel
S
Banai
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D007557:Israel; D016015:Logistic Models; D008297:Male; D010138:Pacemaker, Artificial; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D013256:Steroids; D011241:Prednisone; D006854:Hydrocortisone
Arrhythmias; Interventional cardiology; Valvular heart disease; Vascular biology