Please use this identifier to cite or link to this item: doi:10.22028/D291-39026
Title: Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement
Author(s): Pavlicek, Valérie
Mahfoud, Felix
Bubel, Katharina
Fries, Peter
Ewen, Sebastian
Böhm, Michael
Scheller, Bruno
Ukena, Christian
Language: English
Title: Clinical Research in Cardiology
Publisher/Platform: Springer Nature
Year of Publication: 2023
Free key words: Transcatheter valve replacement
Conduction disturbances
DDC notations: 610 Medicine and health
Publikation type: Journal Article
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 signifcant 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 specifc nor predictive of HAVB and can be skipped. Trial registration number NCT04128384 (https://www.clinicaltrials.gov).
DOI of the first publication: 10.1007/s00392-023-02160-0
URL of the first publication: https://link.springer.com/article/10.1007/s00392-023-02160-0
Link to this record: urn:nbn:de:bsz:291--ds-390264
hdl:20.500.11880/35198
http://dx.doi.org/10.22028/D291-39026
ISSN: 1861-0692
1861-0684
Date of registration: 14-Feb-2023
Faculty: M - Medizinische Fakultät
Department: M - Innere Medizin
M - Radiologie
Professorship: M - Prof. Dr. Michael Böhm
M - Prof. Dr. Bruno Scheller-Clever
M - Keiner Professur zugeordnet
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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