Prosthesis depth and conduction disturbances after last generation balloon-expandable transcatheter aortic valve implantation.
Preliminary data on Sapien 3 valve (S3-THV) use for transcatheter aortic valve implantation have shown an increased permanent pacemaker implantation (PPMI) rate with respect to Sapien XT valve. Aim of this study was to investigate the role of S3-THV position in the left ventricular outflow tract (LVOT) on electrocardiographic changes suggestive of atrioventricular (ΔPR) and/or intraventricular (ΔQRS) conduction abnormalities and 30 days PPMI rate.



Eighty-six consecutive patients treated with S3-THV were included in the study. All patients underwent clinical and electrocardiogram evaluation. Left ventricular outflow tract prosthesis depth was assessed by fluoroscopy and expressed quantitatively (mm) and as aorto-ventricular ratio (AVR). Eight patients (9.3%) needed PPMI at 30 days. A low AVR (≤60/40) predicted PPMI (OR = 6.09, 95% CI 1.19-31.01, P = 0.030) and resulted into higher PPMI rate, compared with higher AVR (30.0 vs. 6.6%, P = 0.017). For each millimetre increase in the LVOT prosthesis depth PPMI risk increased by 1.41 times (95% CI 1.06-1.87, P = 0.017). In patients with low AVR, ΔPR was higher than in those with higher AVR (33.4 ± 56.7 vs. 12.1 ± 19.4 ms, P = 0.021) and ΔPR was associated to LVOT prosthesis depth (β = 0.286, P = 0.009). Furthermore, ΔPR was associated with risk of PPMI (OR = 1.03, 95% CI 1.01-1.06, P = 0.024).



A low AVR is associated to higher ΔPR and PPMI rates. The correlation between LVOT prosthesis depth with ΔPR and higher PPMI rate suggests the need of a careful S3-THV implantation.
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.|Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy.
Fortunato
F
Iacovelli
Interventional Cardiology Service, 'Santa Maria' Clinic, Bari, Italy.
Antonio
A
Pignatelli
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy.
Giuseppe
G
Giugliano
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy.
Eugenio
E
Stabile
Cardiology Unit, 'Di Venere' Hospital, Bari, Italy.
Mariangela
M
Cicala
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Luigi
L
Salemme
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Angelo
A
Cioppa
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Grigore
G
Popusoi
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Armando
A
Pucciarelli
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Sebastiano
S
Verdoliva
Section of Heart Surgery, Department of Emergency and Organ Transplantation, University of Bari 'Aldo Moro', Bari, Italy.
Alessandro Santo
AS
Bortone
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy.
Maria-Angela
MA
Losi
Division of Aortic Surgery, Heart Surgery Unit, 'San Giovanni di Dio e Ruggi d'Aragona' University Hospital, Salerno, Italy.
Enrico
E
Coscioni
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy.
Giovanni
G
Esposito
Interventional Cardiology Service, 'Santa Maria' Clinic, Bari, Italy.
Gaetano
G
Contegiacomo
Interventional Cardiology Service, 'Montevergine' Clinic, Mercogliano, Italy.
Tullio
T
Tesorio
D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007558:Italy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome
Aortic stenosis; Atrioventricular block; Pacemaker implantation