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One-year follow-up of conduction disturbances following transcatheter aortic valve implantation.

Salizzoni, Stefano; Anselmino, Matteo; Fornengo, Cristina; Giordana, Francesca; La Torre, Michele; Moretti, Claudio; D’Amico, Maurizio; Omedé, Pierluigi; Marra, Sebastiano; Rinaldi, Mauro; Gaita, Fiorenzo
Journal of Cardiovascular Medicine: Post Author Corrections: July 9, 2014
doi: 10.2459/JCM.0000000000000179
Original article: PDF Only

Aims: To describe the postprocedural and 1-year follow-up incidence of heart conduction disturbances in patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods: Ninety-five patients were enrolled from 2008 to 2011 (mean age 81.8 +/- 7.2 years, 63.1% women). Clinical and ECG data were recorded at admission, discharge, and 3, 6 and 12 months following TAVI.

Results: Fifty-seven Edwards SAPIEN (31 transapical, 26 transfemoral) and 38 transfemoral CoreValve implants were used. Two (2.1%) patients died during the procedure and 11 (11.6%) patients received a pacemaker prior to discharge (7 CoreValve, 3 transapical, 1 transfemoral SAPIEN; P = 0.18). Among the surviving patients not receiving a pacemaker, TAVI increased the PQ interval (176 +/- 29 vs. 188 +/- 36 ms; P = 0.001), QRS width (90 +/- 15 vs. 108 +/- 26 ms; P < 0.001), and first-grade atrioventricular block (17 vs. 29%; P < 0.001). Postprocedural complete left bundle branch block was reported most in transapical (from 10 to 36%; P = 0.01) and CoreValve (from 8 to 64%; P < 0.001) recipients compared to the transfemoral SAPIEN group. At the 12-month follow-up, 24 (25.3%) patients had died [two (2.1%) sudden deaths] and four (4.2%) required pacemaker implantation. Among the survivors not receiving a pacemaker at the 1-year follow-up, the PQ interval (178 +/- 27 vs. 188 +/- 36 ms; P = 0.39) remained unchanged in the ECG, whereas the QRS width (100 +/- 22 vs. 108 +/- 26 ms; P = 0.008) decreased compared to measurements taken at discharge.

Conclusion: Conduction disturbances following TAVI primarily develop during hospitalization and subsequently stabilize. However, the small percentage of patients suffering sudden death or pacemaker implantation requires attention.

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