Abstract 4374: Persistent Conduction Abnormalities and Requirements for Pacemaking 6 Months After Transcatheter Aortic Valve Implantation
Background: Early conduction abnormalities and need for pacemaking after transcatheter aortic valve implantation (TAVI) is well recognized. It is still unknown, however, if these conduction abnormalities are persistent, and what is the need for permanent pacemaking after 1-month follow-up.
Objective: In this prospective study, we examined the incidence of post-procedural and 6-month conduction abnormalities and need for permanent pacemaking after TAVI. Multivariable logistic regression analysis was performed to identify predictors of new occurrence left bundle branch block (LBBB) and permanent pacemaking.
Methods: We examined the 12-lead electrocardiogram (ECG) of 91 consecutive patients in whom a CoreValve ReValving System was implanted between November 2005 and April 2009. We evaluated the ECGs before treatment, after treatment, at 1-month and 6-month follow-up. The requirement and timing of permanent pacemaking was documented.
Results: The mean age of patients was 81±7 years and the mean logistic EuroSCORE was 16±9%. Median duration of follow-up was 213 days (IQR 64, 519). There was a 38% increase in the frequency of LBBB after TAVI (53 vs. 15%, p<0.001). At 1-month follow-up, the frequency of LBBB decreased from 53 to 43% (p=0.625). Importantly, there was no further decrease in the frequency of LBBB from 1-month (43%) to 6 months (43%) (p=1.0). Permanent pacemaking was required in 17/91 (19%) of patients. A permanent pacemaker was implanted in 8/17 patients (47%) within 7 days of TAVI, in 6/17 (35%) at 7–30 days, and in 3/17 (18%) after 30 days. Pre-existing right bundle branch block, septal wall thickness, pulmonary hypertension and depth of implantation (from base of noncoronary sinus) were identified as independent predictors for the combined endpoint of new LBBB or permanent pacemaking.
Conclusion: These results suggest that early conduction abnormalities occurring after TAVI persist at 6-months follow-up. A significant proportion of patients (35%) had a permanent pacemaker implanted 7–30 days after TAVI. Patient-related, anatomical-related, and procedure-related factors need to be considered in the pathogenesis of conduction abnormalities after TAVI.