Electrocardiographic changes and conduction disturbances after transfemoral aortic valve implantation with Edwards Sapien 3 prosthesis

Unzué, Leire; García, Eulogio; José, Rodríguez Rodrigo Francisco; Javier, Parra Jiménez Francisco; Juan, Medina Peralta; Díaz-Antón, Belén; Miguel, Rodríguez Del Río; Fontenla, Adolfo; Teijeiro, Rodrigo; Rubio-Alonso, Belén

doi:10.1016/j.jelectrocard.2018.02.009

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…The most common CD in our patients after TAVI was LBBB (19.5% in S3 and 19.4% in S3U at discharge), a finding similar to what has been already reported in two previous studies and in a large registry that assessed CD after S3 valve implantation and found a LBBB rate around 20% ( 19 , 21 ). Although LBBB occurring in fragile patients undergoing TAVI has been shown to reduce 1-year death rate (3.3% vs. 13%, p = 0.014), other series gave controversial results suggesting that further studies will be needed to confirm this finding ( 20 , 22 , 23 ).…”

Section: Discussionsupporting

confidence: 91%

“…Although LBBB occurring in fragile patients undergoing TAVI has been shown to reduce 1-year death rate (3.3% vs. 13%, p = 0.014), other series gave controversial results suggesting that further studies will be needed to confirm this finding ( 20 , 22 , 23 ). Interestingly, LBBB in our patients was more frequently observed early after the procedure and showed a tendency to regress at discharge as already observed in previous studies ( 13 , 21 ). Conversely, AV blocks showed a trend to increase at discharge as compared to the early postprocedural time.…”

Section: Discussionsupporting

confidence: 90%

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Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves

Monizzi

Olivares

Makmur

et al. 2022

Front. Cardiovasc. Med.

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BackgroundConduction disorders (CD) are the most common complications after Transcatheter Aortic Valve Implantation (TAVI). The last generation of Edwards balloon expandable valves, the SAPIEN 3 Ultra (S3U), is provided with an external sealing skirt that aims to further reduce paravalvular leakage (PVL) compared to SAPIEN 3 (S3) and could potentially lead to higher CD rate. We sought to investigate the rate of new-onset CD in patients undergoing TAVI with the S3 or S3U valve.MethodsWe included 582 consecutive patients undergoing TAVI in a single high-volume Center. Patients with previously implanted pacemaker and Valve in valve procedures were excluded. CD rate was evaluated early after implantation and at discharge.ResultsNo significant difference in the overall CD rate was found between S3 and S3U patients both immediately after the procedure (S3 45.5% vs. S3U 41.8%, p = 0.575) and at discharge (S3 30.4% vs. S3U 35.6%, p = 0.348) with low rate of permanent pacemaker implantation (S3 6.3% vs. S3U 5.5%, p = 0.749). No significant differences were found also in patients with pre-existing atrial fibrillation (S3 8.2% vs. S3U 5%, p = 0.648). A significantly lower rate of PVL was found with S3U compared to S3 (S3 42% vs. S3U 26%, p = 0.007). According to the manufacturer’s guidelines we confirmed that S3U were implanted in a significantly higher position compared to S3 (S3 4.89 ± 1.57 mm vs. S3U 4.47 ± 1.36 mm, p = 0.001).ConclusionNo significant difference in the rate of CD, including the need for PPM implantation, was found in patients undergoing TAVI with the S3 compared to S3U. Moreover, S3U significantly reduced the PVL rate.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves

Monizzi

Olivares

Makmur

et al. 2022

Front. Cardiovasc. Med.

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“…Post-TAVI PR interval prolongation and QRS axis change are relatively common regardless of subsequent occurrence of delayed HAVB or not because it can be caused by not only a permanent injury of the conduction system but also transient oedema caused by the TAVI procedure per se. 14 , 15 In our analysis, about one-third of patients developed ΔPR interval ≥20 ms within 24 h post-TAVI, nearly 80% of whom subsequently demonstrated a ≥20 ms decrease of their PR interval within the following 24 h. Similarly, one-quarter of patients developed QRS axis change within 24 h post-TAVI, of whom about half showed QRS axis recovery towards their baseline axis within the subsequent 24 h. These findings appear consistent with prior serial ECG studies showing that the majority of BEV recipients harbour early (immediately post-TAVI) ECG change and subsequent (within 24–48 h post-TAVI) recovery. 14–16 The reversibility of those ECG changes may also be related to conflicting results regarding the impact of PR prolongation in prior studies: one study identified ΔPR interval as a predictor of delayed HAVB, 17 while another study did not.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 15 In our analysis, about one-third of patients developed ΔPR interval ≥20 ms within 24 h post-TAVI, nearly 80% of whom subsequently demonstrated a ≥20 ms decrease of their PR interval within the following 24 h. Similarly, one-quarter of patients developed QRS axis change within 24 h post-TAVI, of whom about half showed QRS axis recovery towards their baseline axis within the subsequent 24 h. These findings appear consistent with prior serial ECG studies showing that the majority of BEV recipients harbour early (immediately post-TAVI) ECG change and subsequent (within 24–48 h post-TAVI) recovery. 14–16 The reversibility of those ECG changes may also be related to conflicting results regarding the impact of PR prolongation in prior studies: one study identified ΔPR interval as a predictor of delayed HAVB, 17 while another study did not. 18 More importantly, incremental impact of those ECG changes on the HAVB risk in the presence of pre-existing RBBB has yet to be investigated—representing a unique aspect of the present analysis.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the 2021 European Society of Cardiology guidelines in pre-existing right bundle branch block patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve

Isogai

Dykun

Agrawal

et al. 2022

European Heart Journal Open

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Aims The 2021 European Society of Cardiology guidelines recommend early pacemaker implantation should be considered in pre-existing right bundle branch block (RBBB) patients who develop PR prolongation or QRS axis change after transcatheter aortic valve implantation (TAVI). We aimed to evaluate this recommendation in TAVI recipients with a balloon-expandable valve (BEV). Methods and Results We retrospectively reviewed 188 pre-existing RBBB patients without pre-existing permanent pacemaker (PPM) who underwent TAVI with a BEV at our institution in 2015-2019. Patients who developed high-degree atrioventricular block (HAVB) during TAVI or within 24 hours post-TAVI were excluded. Eligible patients were divided according to the guideline-directed criteria (ΔPR interval ≥20 ms and/or QRS axis change). Patients who met the criteria (n = 102, 54.3%), compared with those who did not (n = 86), had a higher prevalence of baseline right axis deviation and were more likely to have received a larger valve with greater oversizing. The 30-day delayed HAVB rate did not differ significantly between the groups (3.9% vs. 4.7%, p = 1.00; OR = 0.84[95%CI=0.20-3.45]). There was also no significant difference in terms of death (5.0% vs. 8.4% at 1 year; overall log-rank-p=0.94) or a composite of death or PPM (14.8% vs. 16.6% at 1 year; overall log-rank-p=0.94) during follow-up post-TAVI. The majority of PR prolongations (79.4%) and QRS axis changes (52.0%) regressed within the following 24 hours. Conclusion The present data did not demonstrate an association of significant changes in PR interval or QRS axis with HAVB in BEV recipients with pre-existing RBBB. Prospective studies are warranted to confirm these findings.

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One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Dolci¹,

Vollema²,

Kley³

et al. 2019

The American Journal of Cardiology

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Long-term evolution of new-onset conduction abnormalities and need of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) have not been extensively evaluated. We describe the incidence and time course of new conduction abnormalities and the rate of PPI with the new-generation transcatheter aortic valve prosthesis Edwards SAPIEN 3 (S3). In total, 266 patients with severe aortic stenosis who underwent TAVI were retrospectively analyzed. Twelve-lead electrocardiograms at baseline, after TAVI, at discharge, at 1-, 6-, and 12-month follow-up were evaluated to identify conduction abnormalities and PPI requirements to investigate the correlates of PPI. After TAVI, a significant increase in PR interval duration and in QRS complex width was observed. New-onset left bundle branch block was observed in 65 patients (24%) after TAVI. The number of patients with left bundle branch block was maximum at hospital discharge and decreased at 12-month follow-up (39% and 32%, respectively). Thirty-five patients (13%) required PPI during the follow-up. However, paced rhythm was only observed in 7% of the patients with a complete 12-month follow-up. Patients who underwent PPI had a higher prevalence of first-degree atrioventricular block, complete right bundle branch block, and wider QRS complex at baseline. Baseline right bundle branch block and QRS width immediately after TAVI were the only variables independently associated with PPI. In conclusion, conduction disorders have a temporary nature after TAVI and showed a trend toward stabilization during the following months. With this new-generation device, the incidence of new conduction abnormalities requiring PPI is relatively low.Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with symptomatic severe aortic stenosis (AS) and contraindications or high risk for surgical aortic valve replacement. 1 Recently, this treatment has been extended to patients with intermediate operative risk. 2 The increased life expectancy of the population together with the current expansion of the indications for TAVI toward younger and lower surgical risk patients call for efforts to obtain similar (if not better) results than surgical aortic valve replacement which is currently the preferred treatment in these subpopulations. 3 The development of conduction abnormalities and the need for permanent pacemaker implantation (PPI) is a common complication of TAVI. Using the newgeneration transcatheter aortic valves, the incidence of PPI ranges 2.3% to 36.1%. 4 This broad range of PPI incidence relies on the inclusion of patients with pre-existent conduction abnormalities, anatomical factors such as calcification of the left ventricular (LV) outflow tract, and procedural factors such as the design and depth of implantation of the transcatheter aortic valve prosthesis. Interestingly, the time course of TAVI-induced conduction abnormalities has not been fully elucidated and high-degree atrioventricular (AV) block may occur late...

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Electrocardiographic changes and conduction disturbances after transfemoral aortic valve implantation with Edwards Sapien 3 prosthesis

Cited by 8 publications

References 18 publications

Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves

Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves

Evaluation of the 2021 European Society of Cardiology guidelines in pre-existing right bundle branch block patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve

One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

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