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Open Access 21-01-2023 | Aortic Valve Replacement | Original Paper

Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement

Authors: Valérie Pavlicek, Felix Mahfoud, Katharina Bubel, Peter Fries, Sebastian Ewen, Michael Böhm, Bruno Scheller, Christian Ukena

Published in: Clinical Research in Cardiology | Issue 5/2023

Abstract

Aim

Transcatheter aortic valve replacement (TAVR) can cause intraventricular conduction disturbances (ICA), particularly left bundle branch block (BBB) and high-degree atrioventricular block (HAVB). The aim of this study was to investigate clinical, anatomical, procedural, and electrophysiological parameters predicting ICA after TAVR.

Methods

Patients with severe aortic stenosis (n = 203) without pacing devices undergoing TAVR with a self-expanding (n = 103) or balloon-expanding (n = 100) valve were enrolled. Clinical and anatomical parameters, such as length of the membranous septum (MS) and implantation depth, were assessed. His-ventricular interval (HVi) before and after implantation was determined. 12-lead-electrocardiograms (ECG) before, during and after 3 and 30 days after TAVR were analyzed for detection of any ICA.

Results

Among 203 consecutive patients (aortic valve area 0.78 ± 0.18 cm², age 80 ± 6 years, 54% male, left ventricular ejection fraction 52 ± 10%), TAVR led to a significant prolongation of infranodal conduction in all patients from 49 ± 10 ms to 59 ± 16 ms (p = 0.01). The HVi prolongation was independent of valve types, occurrence of HAVB or ICA. Fifteen patients (7%) developed HAVB requiring permanent pacemaker (PPM) implantation and 63 patients (31%) developed ICA within 30 days. Pre-existing BBB (OR 11.64; 95% CI 2.87–47.20; p = 0.001), new-onset left BBB (OR 15.72; 95% CI 3.05–81.03; p = 0.001), and diabetes mellitus (OR 3.88; 95% CI 1.30–15.99; p = 0.02) independently predicted HAVB requiring PPM. Neither pre-existing right BBB, a prolonged postHVi, increases in PR duration, any of the TAVR implantation procedural and anatomic nor echocardiographic characteristics were predictive for later HAVB.

Conclusions

New-onset left BBB and diabetes mellitus independently predicted HAVB requiring PPM after TAVR and helped to identify patients at risk. Electrophysiologic study (EPS) of atrioventricular conduction was neither specific nor predictive of HAVB and can be skipped.

Trial registration number

NCT04128384 (https://www.clinicaltrials.gov).

Graphical abstract

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Title: Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement
Authors: Valérie Pavlicek
Felix Mahfoud
Katharina Bubel
Peter Fries
Sebastian Ewen
Michael Böhm
Bruno Scheller
Christian Ukena
Publication date: 21-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Aortic Valve Replacement
Atrioventricular Block
Aortic Valve Replacement
Aortic Valve Replacement
CSF Drainage
Left Bundle Branch Block
Right Bundle Branch Block
Published in: Clinical Research in Cardiology / Issue 5/2023
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-023-02160-0

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Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement

Abstract

Aim

Methods

Results

Conclusions

Trial registration number

Graphical abstract

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