Interatrial blocks in patients with tavi and their associations with clinic parameters

Abstract

Aims: The present study attempted to evaluate the prevalence of basal interatrial blocks (IABs), their associations with clinical parameters, and the interatrial conduction in the follow-up after a successful transcatheter aortic valve implantation (TAVI) procedure among patients with severe aortic stenosis. Methods: We retrospectively evaluated the findings of 90 patients undergoing TAVI in our center. Overall, we considered the presence and grades of IABs and P-wave durations in electrocardiograms (ECG), preoperative echocardiography (ECHO) findings (maximum and mean gradients and left atrium (LA) diameter), valve size and type, and changes in these parameters at sixth month. Results: Forty-six patients were included in the study which are suitable for the pre-determined inclusion criteria. We found the mean age of the patients to be 74.78 ± 8.66 years. In preoperatively-evaluated ECGs, while we detected partial IABs in 37% of the patients, there were advanced IABs in 6.5%, but 56.5% yielded no interatrial conduction disorder. On the other hand, in postoperatively-evaluated ECGs, while we observed partial IABs in 30.4% of the patients, there were advanced IABs among 21.7% (p = 0.017). Nevertheless, we could not conclude any IABs among 47.8% of the patients. Besides, 54.3% of the patients received a self-expandable valve, and a balloon-expandable valve was inserted in 45.7%. In this regard, we detected partial (7 patients) and advanced (2 patients) IABs in the preoperatively-evaluated ECGs of the patients receiving a self-expandable valve. In the postoperative ECGs of these patients, while the partial IAB remained the same in 4 patients (57.1%), it progressed to an advanced IAB in 3 (42.9%). In addition, while the advanced IAB regressed to a partial IAB in one patient, it remained the same for the other patient. In this group, the mean P-wave durations were found to be 118.4±22.67 before the TAVI and 119.6±21.69 after the TAVI (p = 0.113). In the preoperative ECGs of 21 patients with a balloon-expandable valve, we detected partial IABs in 10 patients and an advanced IAB in one patient. While a partial IAB developed in five patients (p = 0.022), five patients with a partial IAB developed an advanced IAB following the procedure (p = 0.022). In this group, we noticed a significant difference between preoperative (127.62±19.4) and postoperative (138.71+ 32.03) P-wave durations (p = 0.038). Conclusion: In a nutshell, we concluded no significant change in interatrial conduction time of the patients with TAVI compared to the baseline in their sixth-month ECGs. When considered by valve type, we concluded that the development and progression of IABs were significant among those with a balloon-expandable valve. The higher postoperative mean gradient among those with a balloon-expandable valve compared to those with a self-expandable valve may be associated with significantly longer P-wave duration among those with a balloon-expandable valve.