Abstract 232: Acquired Conduction Disturbances After Percutaneous Aortic Valve Replacement
Background: Aortic valve replacement (AVR) is often associated with conduction disturbances. Percutaneous AVR (PAVR) is an upcoming therapy for nonsurgical patients with severe aortic stenosis (AS). The aim of this study was to evaluate conduction disturbances in the setting of PAVR.
Methods: Transfemoral percutaneous AVR was performed in 38 pts (CoreValve Revalving TM n=24/Edwards SAPIEN n=14). We undertook simultaneous recordings of the AV-conductance in the last 14 implanted pts with a 10-pole catheter (Parahis, Biosense Webster), inserted via the right femoral vein and positioned along the His bundle region. AH, HV, PQ and QRS intervals were measured continuously with emphasis on time before/after balloon aortic valvuloplasty (BAV) and after aortic valve implantation, respectively. An additional invasive EP investigation was performed 2–5 d after the procedure. Finally, the valve implantation depth (mm) into the left ventricular outflow tract was assessed by fluoroscopy after CoreValve implantation.
Results: Preprocedural pacemaker (PM) were present in 3 pts (n=2 in CoreValve) and preprocedural bundle branch block (n=1 RBBB, n=4 LBBB all in CoreValve) was present in 5 pts. In 20 pts a new LBBB during and after PAVR was observed (CoreValve n=17/SAPIEN n=3). In 14 of these pts, the LBBB occurred immediately after BAV. HV prolongation occurred immediately after BAV or after PAVR in 10 out of 14 pts with invasive HIS recordings. The majority of the acquired LBBB were persistent. With CoreValve 13 pts and with SAPIEN one had a prophylactic indication for a PM:11 due to a complete AVB and 3 due to a complete LBBB and persistent prolongation of the HV interval, which occurred 2–5 d after the procedure. The prosthesis implantation depth after CoreValve in need of prophylactic PM implantation was significantly greater (>8 mm; p=0.03) as compared conservative therapy.
Conclusion: Percutaneous aortic valve replacement is frequently associated with conduction disturbances which can even occur up to 5 days after the procedure. There is a higher incidence of persistent LBBB and AVB with the CoreValve Revalving TM system. A critical implantation depth (>8 mm) appears to be associated with higher incidence of LBBB or total AVB.