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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: April 2015 - Volume 16 - Issue 4 - p 296–302
doi: 10.2459/JCM.0000000000000179
Original articles

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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aUniversity of Torino – Department of Surgical Sciences, Division of Cardiac Surgery

bUniversity of Torino – Department of Medical Sciences, Division of Cardiology

c‘Città della Salute e della Scienza’ Hospital, Division of Cardiology, Torino, Italy

Correspondence to Stefano Salizzoni, MD, Università degli Studi di Torino, Città della Salute e della Scienza ‘Molinette’ Hospital, Corso Bramante 88-90, 10126 Torino, ItalyTel: +39 011 6335511/+39 335 5454289; fax: +39 011 6336130; e-mail: salizzonis@gmail.com

Received 14 January, 2014

Revised 28 May, 2014

Accepted 28 May, 2014

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© 2015 Italian Federation of Cardiology. All rights reserved.