Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation

Roten, Laurent; Wenaweser, Peter; Delacrétaz, Etienne; Hellige, Gerrit; Stortecky, Stefan; Tanner, Hildegard; Pilgrim, Thomas; Kadner, Alexander; Eberle, Balthasar; Zwahlen, Marcel; Carrel, Thierry; Meier, Bernhard; Windecker, Stephan (2010). Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation. American journal of cardiology, 106(10), pp. 1473-1480. New York, N.Y.: Elsevier 10.1016/j.amjcard.2010.07.012

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Atrioventricular (AV) conduction impairment is well described after surgical aortic valve replacement, but little is known in patients undergoing transcatheter aortic valve implantation (TAVI). We assessed AV conduction and need for a permanent pacemaker in patients undergoing TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards Sapien Valve (ESV). Sixty-seven patients without pre-existing permanent pacemaker were included in the study. Forty-one patients (61%) and 26 patients (39%) underwent successful TAVI with the MCRS and ESV, respectively. Complete AV block occurred in 15 patients (22%), second-degree AV block in 4 (6%), and new left bundle branch block in 15 (22%), respectively. A permanent pacemaker was implanted in 23 patients (34%). Overall PR interval and QRS width increased significantly after the procedure (p <0.001 for the 2 comparisons). Implantation of the MCRS compared to the ESV resulted in a trend toward a higher rate of new left bundle branch block and complete AV block (29% vs 12%, p = 0.09 for the 2 comparisons). During follow-up, complete AV block resolved in 64% of patients. In multivariable regression analysis pre-existing right bundle branch block was the only independent predictor of complete AV block after TAVI (relative risk 7.3, 95% confidence interval 2.4 to 22.2). In conclusion, TAVI is associated with impairment of AV conduction in a considerable portion of patients, patients with pre-existing right bundle branch block are at increased risk of complete AV block, and complete AV block resolves over time in most patients.

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