Predictors and Course of High-Degree Atrioventricular Block After Transcatheter Aortic Valve Implantation Using the CoreValve Revalving system

Guetta, Victor; Goldenberg, Gustavo; Segev, Amit; Dvir, Danny; Kornowski, Ran; Finckelstein, Arik; Hay, Ilan; Goldenberg, Ilan; Glikson, Michael

doi:10.1016/j.amjcard.2011.07.020

Cited by 121 publications

(98 citation statements)

References 16 publications

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“…Due to intrinsic properties of the delivery catheter, the use of the first generation 18Fr CV often resulted in anatomically deep valve implantation. It has been hypothesized that trauma to the interventricular septum by deep insertion of the nitinol frame could impede the conduction tissue which it embeds, resulting in a high incidence of new Left Bundle Branch Block (LBBB) or complete AV-block after valve implantation [4,5]. This might explain the relatively high rate of new pacemaker implantation, as consistently reported by several TAVI registries [6,7].…”

Section: Introductionmentioning

confidence: 52%

Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study

Lenders

Collas

Hernández

et al. 2014

International Journal of Cardiology

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a b s t r a c t a r t i c l e i n f oBackground: Transcatheter Aortic Valve Implantation (TAVI) is now considered an indispensable treatment strategy in high operative risk patients with severe, symptomatic aortic stenosis. However, conduction disturbances and the need for Permanent Pacemaker (PPM) implantation after TAVI with the CoreValve prosthesis still remain frequent. Methods and results: We aimed to evaluate the implantation depth, the incidence and predictors of new conduction disturbances, and the need for PPM implantation within the first month after TAVI, using the new Accutrak CoreValve delivery system (ACV), compared to the previous generation CoreValve (non-ACV). In 5 experienced TAVI-centers, a total of 120 consecutive non-ACV and 112 consecutive ACV patients were included (n = 232). The mean depth of valve implantation (DVI) was 8.4 ± 4.0 mm in the non-ACV group and 7.1 ± 4.0 mm in the ACV group (p = 0.034). The combined incidence of new PPM implantation and new LBBB was 71.2% in the non-ACV group compared to 50.5% in the ACV group (p = 0.014). DVI (p = 0.002), first degree AV block (p = 0.018) and RBBB (p b 0.001) were independent predictors of PPM implantation. DVI (p b 0.001) and pre-existing first degree AV-block (p = 0.021) were identified as significant predictors of new LBBB. Conclusion: DVI is an independent predictor of TAVI-related conduction disturbances and can be reduced by using the newer CoreValve Accutrak delivery system, resulting in a significantly lower incidence of new LBBB and new PPM implantation.

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Section: Introductionmentioning

confidence: 52%

Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study

Lenders

Collas

Hernández

et al. 2014

International Journal of Cardiology

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“…The main risks for PPI after TAVI include preexistent right bundle branch block, self-expandable prosthesis valve, and depth of implantation. 22,23 New-onset LBBB was a predictive factor of high-grade atrioventricular (AV) block following TAVI. 24 Some reports showed that complete AV block, Mobitz type second-degree AV block, and sinus-node dysfunction were the common indications for PPI following TAVI.…”

Section: Permanent Pacemaker Implantation In New-onset Persistent Lefmentioning

confidence: 99%

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

Ando

Takagi

2016

Clinical Cardiology

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New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common conduction disturbances after transcatheter aortic valve implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically negative impact after TAVI. To find out, we conducted a systematic literature search of the MEDLINE/PubMed and Embase databases. Observational studies that reported clinical outcomes of NOP-LBBB patients after TAVI were included. The random-effects model was used to combine odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios when available. A total of 4049 patients (807 and 3242 patients with and without NOP-LBBB, respectively) were included. Perioperative (in-hospital or 30-day) and midterm all-cause mortality and midterm cardiovascular mortality were comparable between the groups. The NOP-LBBB patients experienced a higher rate of permanent pacemaker implantation (HR: 2.09, 95% confidence interval: 1.12-3.90, P = 0.021, I 2 = 83%) during midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher permanent pacemaker implantation but did not negatively affect the midterm prognosis. Therefore, careful observation during the follow-up is required.

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“…In another analysis, a proportion of AV conduction disturbances after the intervention has been shown to recover at 3 months of follow-up, and only 40% of the permanent pacemaker patients for highdegree AV block still had an AV block underlying their paced rhythm [32]. Without any clinical signs for pacemaker requirements our approach to wait and observe has been safe in our patient population.…”

Section: Intraventricular Conduction Impairmentmentioning

confidence: 99%

Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol

et al. 2017

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Predictors and Course of High-Degree Atrioventricular Block After Transcatheter Aortic Valve Implantation Using the CoreValve Revalving system

Cited by 121 publications

References 16 publications

Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study

Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol

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