Abstract 17450: Conduction Abnormalities May Be Transient Following Transcatheter Aortic Valve Replacement with the Edwards-Sapien Prosthesis
Objective: Transcatheter aortic valve replacement (TAVR) is a new technique for the treatment of severe aortic stenosis in patients deemed inoperable. Conduction abnormalities are not uncommon, especially left bundle branch block (LBBB), but may be transient. We sought to describe the time course of electrocardiographic disturbances and their resolution in patients who underwent TAVR with the Edwards-Sapien prosthesis (ES) after FDA approval in the US.
Methods: Between December 2011 and April 2012, fifty-seven patients underwent implantation of the Edwards-Sapien prosthesis for clinical indications at a high volume center in the United States. One patient was excluded from the analysis by intra-procedural death, and eleven were excluded because of prior ventricular pacing. Electrocardiograms (ECG) before TAVR, immediately after, and at discharge from the hospital were analyzed for LBBB, QRS duration, PR interval, and atrioventricular block (AVB) requiring permanent pacemaker. QRS widening was considered a change in QRS duration from < 120 ms to > 120 ms; PR prolongation was considered a change in PR interval from < 200 ms to > 200 ms.
Results: LBBB was the most common new conduction abnormality (14/42, 33.3%), appearing immediately post-TAVR in 10/42 (23.8%), and prior to discharge in 4/42 (9.5%). LBBB was transient in 3/10 (30%) of patients in the immediately post-TAVR group. Of the patients with narrow QRS pre-TAVR, 9/28 (32.1%) developed QRS widening, with 8/28 (28.6%) immediately post-procedure and 1/28 (3.6%) prior to discharge. Three patients (37.5%) had transient widening of their QRS interval. Of those with pre-procedure PR < 200, 3/21 (14.3%) developed PR prolongation immediately post-TAVR; all 3 recovered prior to discharge. Of those without a permanent pacemaker (PPM), 3/42 (7.1%) developed high grade AVB requiring a PPM. No patients developed transient high grade AVB.
Conclusions: Conduction abnormalities after TAVR with the Edwards-Sapien valve are not uncommon. Some of these are transient changes that improve during post-TAVR hospital care. Physicians should be aware of this when deciding on the need for permanent pacing after TAVR.
- © 2012 by American Heart Association, Inc.