BACKGROUND: Conduction disturbances (CD) are the most frequent complication after transcatheter aortic valve replacement (TAVR), and there continues to be a lack of consensus on their management. OBJECTIVE: To assess new CD and permanent pacemaker (PPM) implantation after TAVR and to evaluate the ventricular pacing percentage (VP) up to 1 year of follow-up. METHODS: Patients who underwent TAVR from October 2014 to November 2019 were enrolled; patients with previous PPM were excluded. Clinical, procedure, ECG, and PPM data were collected up to 1 year after implantation. The significance level adopted in the statistical analysis was 0.05. RESULTS: A total of 340 patients underwent TAVR. The most frequent CD was the new left bundle branch block (LBBB; 32.2%), which 56% resolved after 6 months. Right bundle branch block (RBBB) was the biggest risk factor for advanced atrioventricular block (AVB) [OR=8.46; p<0.001] and PPM implantation [OR=5.18, p<0.001], followed by previous low-grade AVB [OR=2.25; p=0.016 for PPM implantation]. Regarding procedure characteristics, newer generation valves and valve-in-valve procedures were associated with fewer CDs. Overall, 18.5% of patients had a PPM implanted post-TAVR. At first PPM evaluation, patients with advanced AVB had a median percentage of VP of 80% and 83% at one year. Regarding patients with LBBB plus low-grade AVB, median VP was lower (6% at first assessment, p=0.036; 2% at one year, p = 0.065). CONCLUSION: LBBB was the most frequent CD after TAVR, with more than half being resolved in the first six months. RBBB was the major risk factor for advanced AVB and PPM implantation. Advanced AVB was associated with a higher percentage of VP at 1 year of follow-up.
BACKGROUND: Conduction disturbances (CD) are the most frequent complication after transcatheter aortic valve replacement (TAVR), and there continues to be a lack of consensus on their management. OBJECTIVE: To assess new CD and permanent pacemaker (PPM) implantation after TAVR and to evaluate the ventricular pacing percentage (VP) up to 1 year of follow-up. METHODS: Patients who underwent TAVR from October 2014 to November 2019 were enrolled; patients with previous PPM were excluded. Clinical, procedure, ECG, and PPM data were collected up to 1 year after implantation. The significance level adopted in the statistical analysis was 0.05. RESULTS: A total of 340 patients underwent TAVR. The most frequent CD was the new left bundle branch block (LBBB; 32.2%), which 56% resolved after 6 months. Right bundle branch block (RBBB) was the biggest risk factor for advanced atrioventricular block (AVB) [OR=8.46; p<0.001] and PPM implantation [OR=5.18, p<0.001], followed by previous low-grade AVB [OR=2.25; p=0.016 for PPM implantation]. Regarding procedure characteristics, newer generation valves and valve-in-valve procedures were associated with fewer CDs. Overall, 18.5% of patients had a PPM implanted post-TAVR. At first PPM evaluation, patients with advanced AVB had a median percentage of VP of 80% and 83% at one year. Regarding patients with LBBB plus low-grade AVB, median VP was lower (6% at first assessment, p=0.036; 2% at one year, p = 0.065). CONCLUSION: LBBB was the most frequent CD after TAVR, with more than half being resolved in the first six months. RBBB was the major risk factor for advanced AVB and PPM implantation. Advanced AVB was associated with a higher percentage of VP at 1 year of follow-up.
Authors: Patrick Houthuizen; Robert M A van der Boon; M Urena; N Van Mieghem; Guus B R Brueren; Thomas T Poels; Leen A F M Van Garsse; Josep Rodés-Cabau; Frits W Prinzen; Peter de Jaegere Journal: EuroIntervention Date: 2014-02 Impact factor: 6.534
Authors: Josep Rodés-Cabau; Kenneth A Ellenbogen; Andrew D Krahn; Azeem Latib; Michael Mack; Suneet Mittal; Guillem Muntané-Carol; Tamim M Nazif; Lars Sondergaard; Marina Urena; Stephan Windecker; François Philippon Journal: J Am Coll Cardiol Date: 2019-08-27 Impact factor: 24.094
Authors: Enrico Ferrari; Stefan Stortecky; Dik Heg; Olivier Muller; Fabian Nietlispach; David Tueller; Stefan Toggweiler; Stéphane Noble; Francesco Maisano; Marco Roffi; Raban Jeger; Jürg Grünenfelder; Christoph Huber; Stephan Windecker; Peter Wenaweser Journal: Eur J Cardiothorac Surg Date: 2019-07-01 Impact factor: 4.191
Authors: Fred M Kusumoto; Mark H Schoenfeld; Coletta Barrett; James R Edgerton; Kenneth A Ellenbogen; Michael R Gold; Nora F Goldschlager; Robert M Hamilton; José A Joglar; Robert J Kim; Richard Lee; Joseph E Marine; Christopher J McLeod; Keith R Oken; Kristen K Patton; Cara N Pellegrini; Kimberly A Selzman; Annemarie Thompson; Paul D Varosy Journal: Circulation Date: 2018-11-06 Impact factor: 29.690
Authors: Troels H Jørgensen; Ole De Backer; Thomas A Gerds; Gintautas Bieliauskas; Jesper H Svendsen; Lars Søndergaard Journal: JACC Cardiovasc Interv Date: 2018-08-13 Impact factor: 11.195
Authors: Josep Rodés-Cabau; Marina Urena; Luis Nombela-Franco; Ignacio Amat-Santos; Neal Kleiman; Antonio Munoz-Garcia; Felipe Atienza; Vicenç Serra; Marc W Deyell; Gabriela Veiga-Fernandez; Jean-Bernard Masson; Victoria Canadas-Godoy; Dominique Himbert; Javier Castrodeza; Jaime Elizaga; Jaume Francisco Pascual; John G Webb; Jose Maria de la Torre; Lluis Asmarats; Emilie Pelletier-Beaumont; François Philippon Journal: JACC Cardiovasc Interv Date: 2018-07-18 Impact factor: 11.195
Authors: Ibrahim Akin; Stephan Kische; Lylia Paranskaya; Henrik Schneider; Tim C Rehders; Ulrich Trautwein; Gökmen Turan; Dietmar Bänsch; Olga Thiele; Dimitar Divchev; Ilkay Bozdag-Turan; Jasmin Ortak; Gunther Kundt; Christoph A Nienaber; Hüseyin Ince Journal: BMC Cardiovasc Disord Date: 2012-10-04 Impact factor: 2.298