Background

Disturbances in atrioventricular conduction and further need for permanent pacemaker are common complications after transcatheter aortic valve replacement (TAVR).

Objective

The objective was to determine the incidence and type of conduction disturbances associated to TAVR using Edwards SAPIEN valves.

Objective

The objective was to determine the incidence and type of conduction disturbances associated to TAVR using Edwards SAPIEN valves.

Methods

In 125 consecutive patients with symptomatic, severe aortic stenosis undergoing TAVR, a standard 12-lead electrocardiogram was obtained before and serially after the procedure. The cohort was divided into 2 groups with regard to the post-TAVR appearance of conduction disturbances, defined as left bundle branch block (LBBB), right bundle branch block (RBBB), fascicular hemiblocks, atrioventricular block, and the need of permanent pacemaker implantation. Clinical and procedural characteristics were compared among both groups.

Results

Population mean age was 84.4 ± 5.7 years, (50 men, 23 mm valve 81/125). Transapical access was used for 38 patients (30.4%) and transfemoral in 87 (69.6%). After TAVR, 25 patients (20%) presented new conduction defect: 5 patients (4%) required permanent pacemaker implantation due to advanced AV block; new LBBB appeared in 5 (4%) and left anterior hemiblock (LAHB) in 9 (7.2%). No new RBBB and left posterior hemiblock were observed. Patients showed an increase in heart rate, QRS duration, and QTc interval after the procedure. A slight decrease in PR interval was observed ( Table 1 ). There was no significant difference in clinical and procedural characteristics between those with and those without new conduction defects.

Table 1

	Baseline ( N =125)	Postprocedure ( N =125)	P value
Heart rate (beat/min)	67.1 ± 13.3	80.4 ± 17.1	<.001
Rhythm sinus	107 (85.6%)	97 (77.6%)	.53
AF	18 (14.49%)	22 (17.6%)	.57
Pacemaker	0 (0.0%)	6 (4.8%)	.03
PR interval (ms)	195.1 ± 43.0	182.0 ± 38.7	<.001
QRS width (ms)	109.9 ± 29.3	115.3 ± 28.5	<.001
Corrected QT (ms)	458.1 ± 39.3	467.8 ± 81.5	<.001
AV blocks
1st degree	27 (21.6%)	24 (19.2%)	.70
2nd degree	0	0	0
3rd degree	0	3 (2.4%)	.12
Bundle-branch blocks
LBBB	11 (8.8%)	15 (12%)	.48
RBBB	13 (10.4%)	10 (8%)	.58
LAHB	19 (15.2%)	22 (17.6%)	.67
LPHB	1 (0 8%)	1 (0.8%)	1.00

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