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Clinical Trial
. 2023 May;112(5):677-690.
doi: 10.1007/s00392-023-02160-0. Epub 2023 Jan 21.

Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement

Valérie Pavlicek  1 , Felix Mahfoud  2 , Katharina Bubel  3 , Peter Fries  3 , Sebastian Ewen  2 , Michael Böhm  2   4 , Bruno Scheller  2 , Christian Ukena  2
Affiliations
Clinical Trial

Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement

Valérie Pavlicek et al. Clin Res Cardiol. 2023 May.

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 ).

Keywords: Conduction disturbances; Transcatheter valve replacement.

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Conflict of interest statement

FM has received scientific support and speaker honoraria from Bayer, Boehringer Ingelheim, Medtronic, and ReCor Medical. SE has received speaker honoraria from Medtronic, Recor, Bayer, Daiichi Sankyo, Novartis, AstraZeneca, Akcea Therapeutics and Pfizer. MB has received scientific support and speaker honoraria from Abbot, Amgen, Bayer, Boehringer Ingelheim, Medtronic, Novartis, Servier and ReCor Medical. CU has received scientific support and speaker Honoria from Bayer, Pfizer, Medtronic, and ReCor Medical. All other authors have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Study flow chart. TAVR transcatheter valve replacement, ECG electrocardiogram, CT computed tomography, PPM permanent pacemaker, ICD implanted cardioverter defibrillator, EPS electrophysiologic study
Fig. 2
Fig. 2
Duration of the His-ventricular interval (HVi) pre and post transcatheter valve replacement (TAVR). A Example for a measurement of HVi during electrophysiologic study. B HVi duration pre TAVR (49 ± 10 ms) and post TAVR (59 ± 16 ms) in all patients (n = 203, p < 0.01). C HVi duration pre TAVR (49 ± 10 ms) and post TAVR (58 ± 16 ms) in patients with no high-degree atrioventricular block (HAVB) requiring permanent pacemaker (PPM) (p < 0.01, n = 188). D HVi duration pre-TAVR (49 ± 7 ms) and post-TAVR (62 ± 17 ms) in patient with HAVR requiring PPM (p < 0.01, n = 15). E HVi duration pre-TAVR (49 ± 10 ms) and post-TAVR (58 ± 15 ms) in patients with no intraventricular conduction abnormality (ICA) (p < 0.01, n = 140). F HVi duration pre-TAVR (49 ± 10 ms) and post TAVR (58 ± 18 ms) in patients with ICA (p < 0.01, n = 63)
See this image and copyright information in PMC

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