One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Abstract

Long-term evolution of new-onset conduction abnormalities and need of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) have not been extensively evaluated. We describe the incidence and time course of new conduction abnormalities and the rate of PPI with the new-generation transcatheter aortic valve prosthesis Edwards SAPIEN 3 (S3). In total, 266 patients with severe aortic stenosis who underwent TAVI were retrospectively analyzed. Twelve-lead electrocardiograms at baseline, after TAVI, at discharge, at 1-, 6-, and 12-month follow-up were evaluated to identify conduction abnormalities and PPI requirements to investigate the correlates of PPI. After TAVI, a significant increase in PR interval duration and in QRS complex width was observed. New-onset left bundle branch block was observed in 65 patients (24%) after TAVI. The number of patients with left bundle branch block was maximum at hospital discharge and decreased at 12-month follow-up (39% and 32%, respectively). Thirty-five patients (13%) required PPI during the follow-up. However, paced rhythm was only observed in 7% of the patients with a complete 12-month follow-up. Patients who underwent PPI had a higher prevalence of first-degree atrioventricular block, complete right bundle branch block, and wider QRS complex at baseline. Baseline right bundle branch block and QRS width immediately after TAVI were the only variables independently associated with PPI. In conclusion, conduction disorders have a temporary nature after TAVI and showed a trend toward stabilization during the following months. With this new-generation device, the incidence of new conduction abnormalities requiring PPI is relatively low.Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with symptomatic severe aortic stenosis (AS) and contraindications or high risk for surgical aortic valve replacement. 1 Recently, this treatment has been extended to patients with intermediate operative risk. 2 The increased life expectancy of the population together with the current expansion of the indications for TAVI toward younger and lower surgical risk patients call for efforts to obtain similar (if not better) results than surgical aortic valve replacement which is currently the preferred treatment in these subpopulations. 3 The development of conduction abnormalities and the need for permanent pacemaker implantation (PPI) is a common complication of TAVI. Using the newgeneration transcatheter aortic valves, the incidence of PPI ranges 2.3% to 36.1%. 4 This broad range of PPI incidence relies on the inclusion of patients with pre-existent conduction abnormalities, anatomical factors such as calcification of the left ventricular (LV) outflow tract, and procedural factors such as the design and depth of implantation of the transcatheter aortic valve prosthesis. Interestingly, the time course of TAVI-induced conduction abnormalities has not been fully elucidated and high-degree atrioventricular (AV) block may occur late...

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

“… 9 Regarding the baseline first‐degree atrioventricular block, Dolci et al and Naveh et al showed an increased incidence of PPM placement at 1 year of TAVR. 46 , 91 By contrast, we believe that a first‐degree atrioventricular block is a mere delay of atrioventricular conduction rather than a true block and that is why our study demonstrated no impact of first‐degree heart block on the need for PPM implantation.…”

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

“…Table 1 shows the baseline characteristics of the included studies. The 36 studies included a total of 55,851 patients in the final analysis, from 2005 to 2018 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. The mean age of the patients was 81.9 years, with a mean STS score of 8.3.…”

“…In this study, the cumulative proportion of RBBB among the included studies reached 9.2%, also in accordance with the studies of Auffret and colleagues [ 45 ], reporting a prevalence of RBBB of 10.3% in TAVI candidates. Several studies have already highlighted the role of pre-existing RBBB in the development of atrioventricular conduction, leading to post-TAVI PPI [ 2 , 3 , 22 , 26 , 33 , 39 , 41 ]. Our findings confirm the impact of such a condition on post-TAVI PPI, without the influence of age or LVEF.…”

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

“…Ultimately, 23 studies were identified and provided data for the research analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 An additional 30 studies are considered in Appendix E1 because of their limited sample size (<250 patients). The flowsheet for selection of included studies is represented in Figure 1 .…”