Abstract 14908: Interventricular Septal Morphology as a New Predictor of AV-block After Transcatheter Self-expandable Aortic Valve Implantation
Objective. Atrioventricular conduction impairment is a well known complication after CoreValve transcatheter aortic valve implantation (TAVI). Baseline right bundle branch block and the depth of the device in relation to the non-coronary cusp have been described as predictors of the need of pacemaker implantation (PI). In this study, we assessed the impact of interventricular septal morphology by 64-slice computed tomography (CT) on the incidence of complete AV-block after TAVI.
Methods. We analyzed our series of 110 patients (pts), 77±5 years of age, with severe aortic stenosis treated with TAVI. Four pts with previous PI were excluded. Clinical, electrocardiographic, echocardiographic, angiographic and procedural variables were analysed. CT variables were also included: maximal septal thickness (mm) and distance from aortic annulus to subannular septal bulge (A-SSB) (figure).
Results. Complete AV-block requiring PI occurred in 28 pts (26%). No clinical or ecocardiographic variables affected the need of PI. The depth of the device in relation to the non-coronary cusp did not affect AV-block presentation (13.2±4 vs 12.7±4 mm; p: ns). The only electrocardiographic predictor of PI was the presence of baseline right bundle branch block (76% vs 17%; p<0.001). Regarding CT analysis, pts needing PI had a shorter A-SSB distance (15±5 vs 19±6 mm; p<0.05). There was a tendency towards significant difference in maximum septal interventricular thickness between patients with and without complete AV-block (16±4 vs 18±3 mm; p<0.1).
Conclusions: CT provides useful information about the anatomy of the interventricular septum and the left-ventricle outflow tract, helping to identify patients at higher risk of complete AV-block after TAVI.
- © 2011 by American Heart Association, Inc.