Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis

Castro-Mejía, Alex F.; Amat‐Santos, Ignacio J.; Ortega-Armas, María Elizabeth; Baz, José Antonio; Moreno, Raúl; Díaz, J.F. Jiménez; Travieso, Alejandro; Jiménez‐Quevedo, Pilar; Santos‐Martínez, Sandra; McInerney, Angela; Galeote, Guillermo; Díaz, Víctor Alfonso Jiménez; Garrido, Jessica Roa; Tirado‐Conte, Gabriela; Barrero, Alejandro; Marroquín, Luis; Núñez‐Gil, Iván J.; Gonzalo, Nieves; Fernández‐Ortíz, Antonio; Escaned, Javier; Nombela‐Franco, Luis

doi:10.1016/j.ijcard.2022.05.014

Cited by 6 publications

(8 citation statements)

References 35 publications

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“…As PR interval ≥ 240 is considered higher risk, 7 , 10 we compared patients who showed these values (either at baseline or on maximal PR interval ECG) with patients who exhibited shorter PR interval duration. Patients with narrow QRS and PR interval ≥ 240 ms were more often males, and their QRS was wider.…”

Section: Resultsmentioning

confidence: 99%

“…PR prolongation as a risk factor for the development of post-TAVI CHB was mainly studied as an adjunct to new-onset LBBB or baseline right bundle branch block (RBBB), demonstrating higher atrio-ventricular block (AVB) risk in both situations. 7 , 10–12 The few studies reporting on patients with prolonged PR and narrow QRS included only a limited patient cohort, and it was unknown whether there were any post-procedural dynamic QRS duration changes that fell below 120 ms (i.e. a patient with PR > 200 ms and dynamic changes in QRS from baseline of 80 to110 ms or axis change would fit into this subgroup).…”

Section: Introductionmentioning

confidence: 99%

“…a patient with PR > 200 ms and dynamic changes in QRS from baseline of 80 to110 ms or axis change would fit into this subgroup). 7 , 10 …”

Section: Introductionmentioning

confidence: 99%

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Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance

Perel,

Tovia-Brodie,

Schnur

et al. 2023

Europace

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Aims Conduction abnormalities post-transcatheter aortic valve implantation (TAVI) are common. Post-TAVI PR prolongation was mainly studied as an adjunct to new-onset bundle branch block. The net effect of isolated PR prolongation (IPRP) without post-TAVI QRS changes is not well known. The aim of this study was to define the incidence and clinical significance of post-TAVI IPRP. Methods and results A total of 1108 consecutive TAVI patients were reviewed. Patients with IPRP were compared with patients without post-TAVI electrocardiogram (ECG) changes. Clinical outcomes included permanent pacemaker implantation (PPI) and overall mortality. A total of 146 patients with IPRP were compared with 290 patients without post-TAVI ECG changes. At 1 year follow-up, 4 (2.7%) and 7 (2.4%) patients underwent PPI (P = 0.838) and 10 (6.8%) and 25 (8.6%) died (P = 0.521), from the study and control groups, respectively. No patient with IPRP and narrow QRS underwent PPI during 1 year post-TAVI, and all death events were non-cardiac except one unknown cause. Permanent pacemaker implantation rates among patients with IPRP and wide QRS were higher (n = 4, 12.1%), compared with patients with wide QRS without post-TAVI ECG change (n = 3, 4%) however not reaching statistical significance (P = 0.126). Multivariate Cox proportional hazards model demonstrated that in patients with narrow QRS, neither PR prolongation nor baseline or maximal PR intervals was associated with the combined endpoint of PPI and mortality. However, in patients with wide QRS, baseline PR intervals and QRS width, but not PR prolongation were associated with the combined outcome. Conclusion Post-TAVI IPRP in patients with narrow QRS is not associated with adverse outcome. This finding may translate clinically into a more permissive approach to these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance

Perel,

Tovia-Brodie,

Schnur

et al. 2023

Europace

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“…The length of the membrane septum and the depth of valve implantation are relevant for new onset LBBB and permanent pacemaker implantation. 35 , 36 Sixth, although the multivariate Cox regression and IPTW analyses were performed, the baselines of each group differed greatly. This study was an observational study and could only be adjusted with measured covariates.…”

Section: Discussionmentioning

confidence: 99%

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Saito,

Inohara,

Tsuruta

et al. 2024

JACC: Asia

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“…However, some studies have suggested that both THV implantation depth and oversize are not consistently independent predictors of PPI necessity after TAVR ( 49 ). Recently, the differences between membranous septum length and THV implantation depth (ΔMSID) ( 68 ) and valve recapture ( 69 ) have been shown to predict the onset of post-TAVR conduction system disease, with a ΔMSID < 0 being deemed to be the strongest and most unique modifiable predictor ( 68 ). Further studies have shown that both the coronal ΔMSID measured on preoperative CT and the infra-annular ΔMSID measured on postoperative angiography are variable predictors of conduction abnormalities after TAVR, with the coronal ΔMSID being more predictive (95.9% vs. 87.2%; p = 0.002) ( 70 ).…”

Section: Predictors Of Conduction Abnormalities After Tavrmentioning

confidence: 99%

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

Yu,

Fu,

Xia

et al. 2024

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) has increasingly become a safe, feasible, and widely accepted alternative surgical treatment for patients with severe symptomatic aortic stenosis. However, the incidence of conduction abnormalities associated with TAVR, including left bundle branch block (LBBB) and high-degree atrioventricular block (HAVB), remains high and is often correlated with risk factors such as the severity of valvular calcification, preexisting conditions in patients, and procedural factors. The existing research results on the impact of post-TAVR conduction abnormalities and permanent pacemaker (PPM) requirements on prognosis, including all-cause mortality and rehospitalization, remain contradictory, with varied management strategies for post-TAVR conduction system diseases across different institutions. This review integrates the latest research in the field, offering a comprehensive discussion of the mechanisms, risk factors, consequences, and management of post-TAVR conduction abnormalities. This study provides insights into optimizing patient prognosis and explores the potential of novel strategies, such as conduction system pacing, to minimize the risk of adverse clinical outcomes.

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Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis

Cited by 6 publications

References 35 publications

Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance

Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

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