Unbound MEDLINE

Atrioventricular conduction after transcatheter aortic valve implantation and surgical aortic valve replacement.

Abstract

INTRODUCTION
Atrioventricular conduction abnormalities (AVCA) may complicate transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). The aim of this study was to prospectively evaluate AVCA after TAVI and SAVR.
METHODS AND RESULTS
Among 50 patients undergoing TAVI and 25 patients undergoing SAVR a continuous 7-day Holter electrocardiogram (ECG) was recorded after the procedure. ECGs during TAVI and 12-lead ECGs before and 1 and 7 days after TAVI and SAVR were analyzed. At baseline, TAVI patients were older (mean 82.1 vs 75.4, P < 0.001), had a longer PR interval (median 200 milliseconds vs 175 milliseconds, P = 0.004) and broader QRS width (median 100 milliseconds vs 80 milliseconds, P = 0.007) than SAVR patients. New AVCA were observed among 29 TAVI patients (58%), mostly new left bundle branch block (76%). Predilatation induced new AVCA in 14 TAVI patients (28%). New AVCA resolved within 24 hours in 15 TAVI patients (30%), and persisted in 14 TAVI (28%) and 3 SAVR patients (12%, P = 0.12). Among patients with persistent QRS width <120 milliseconds during the first 24 hours after TAVI, QRS width remained stable during the remainder of the observation period. During Holter monitoring complete AV block was observed in 4 TAVI patients (8%) and 3 SAVR patients (12%; P = 0.68).
CONCLUSIONS
Almost half of AVCA during TAVI are induced by predilatation, but half of them resolve within 24 hours. Persistent AVCA are more frequently observed after TAVI than SAVR. If QRS width is below 120 milliseconds the first day after TAVI, the risk of late AVCA seems low.

Links

  • Publisher Full Text

    • Authors

    Roten L, Stortecky S, Scarcia F, Kadner A, Tanner H, Delacrétaz E, Meier B, Windecker S, Carrel T, Wenaweser P

    Institution

    Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.

    Source

    Journal of cardiovascular electrophysiology 23:10 2012 Oct pg 1115-22

    MeSH

    Action Potentials
    Aged
    Aged, 80 and over
    Aortic Valve
    Atrioventricular Block
    Cardiac Catheterization
    Chi-Square Distribution
    Electrocardiography, Ambulatory
    Female
    Heart Valve Prosthesis Implantation
    Humans
    Male
    Predictive Value of Tests
    Prospective Studies
    Risk Factors
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22587564