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low gradient (LF/LG) severe aortic stenosis (AS) with preserved EF constitutes a real challenge with no clear method to confirm the severity of AS in this group. Normal flow/ low gradient AS with preserved EF is considered as echocardiography miscalculation by guidelines. Using pressure wire for aortic stenosis assessment may offer a safe and higher quality technique to assess the severity of AS in LF/LG and NF/LG AS with preserved EF.METHODS 104 Sequential patients with AVA 50% underwent right and left heart cath by two operators with pressure gradients via left ventricular (St. Jude) pressure wire and ascending aorta catheter. Of these, there were 57 with high gradient (HG), 33 with LF/ LG and 14 with NF/LG. Cath derived values were based on simultaneous pressure wire recording of left ventricular pressure and fluid filled pressure catheter recording of aortic pressure measured > 5 cm above the valve. Cardiac output was calculated by thermodilution.RESULTS While the classification of severe AS by cath and echocardiography was concordant in 96% of HG AS patients (55/57), there was large discrepancy of this classification in patients with LF/LG and NF/LG. Severe AS was confirmed with cardiac in 67% of LF/LG patients (22/33) and 43% of those with NF/LG (6/14). No clinical strokes or TIA were observed in the 30 days after procedure in any of the patients.CONCLUSIONS Invasive hemodynamic assessment of AS can be beneficial in identifying true severe AS in patients with LF/LG and NF/ LG severe AS with preserved EF.BACKGROUND Right bundle branch block is an independent predictor of permanent pacemaker implantation after TAVI. This multicenter collaboration sought to further elucidate the risk for permanent pacemaker implantation (PPI) in patients with baseline RBBB and categorize for different transcatheter heart valve designs.METHODS We pooled data on TAVI patients from 4 high-volume centers in Europe and selected those with RBBB at baseline. RESULTSThree hundred eleven (311) patients with RBBB at baseline were included in the analysis. Median age was 85 (IQR 80-88) and 64% was male. Median STS-score was 7 (IQR 5-10), Femoral access was performed in 85%, compared to 9% and 6% for transsubclavian and transapical, respectively. Following transcatheter valve design were used: CoreValve in 134 cases, Sapien XT in 126 cases, Sapien 3 in 29 cases, Lotus in 15 cases and DirectFlow in 7 cases. Overall permanent pacemaker implantation rate after TAVI was 41%, 71% with the Lotus valve, 46% with CoreValve, 38% with Sapien XT, 24% with Sapien 3 and 14% with DirectFlow. The indication for permanent pacemaker implantation was high degree atrioventricular block in 97% of the cases. Ventricular paced rhythm was observed in 45% of the patients at 30-day follow-up visit. Thirty-day and 1-year mortality were 6% and 17%, respectively.CONCLUSION RBBB at baseline is associated with a high incidence of permanent pacemaker implantation for all transcatheter heart valve types. Need for new permanent pacemaker seems highest for the Lotus Valve...

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