Intra-Hisian Block During Transcatheter Aortic Valve Implantation With the CoreValve Prosthesis

Conduction disorders in the setting of transcatheter aortic valve implantation: a clinical perspective

“…Thus, in surgical series atrioventricular block are mainly related to surgical trauma to the cardiac conduction system during excision of the valve or to myocardial ischemia. On the contrary, during TAVI, the injury to the conduction system is assumed to be induced by mechanical trauma, causing edema and necrosis [] at the level of membranous septum during different procedural steps that include: aortic valve crossing, guidewires exchange, and manipulation, positioning of bulky catheter systems in the left ventricle, balloon predilatation, and valve deployment with compression of the native calcified aortic leaflets remained in situ . Among them, the most critical procedural steps for the development of CDs during TAVI seem to be the predilatation and valve deployment, as reported by others [].…”

“…Large‐sized studies with longer follow‐up will define the predictors of PPM after TAVI to select appropriately those TAVI patients at high risk for PPM and thus to improve the preventive measures and the management of these patients. New evidence are mounting on the potential usefulness of the electrophysiological studies in patients selected for TAVI to explore new predisposing factors and to differentiate supra‐, intra‐ or infra‐Hisian blocks []. Finally, important information on the time‐course of CD after TAVI may be obtained from interrogation of PPM during follow‐up.…”

Transatlantic perspectives on TAVI: from essential infrastructure and integration to expansion, research and development: Table 1

“…Postoperative care and evaluation of complications is generally performed with transthoracic echocardiographic assessment of TAVI location and function. The Heart Team is supplemented in appropriate cases with a number of subspecialty services, including electrophysiologists in the event of conduction system disturbances,28 neurologists in the event of a neurological deficit, heart failure specialists for the management of pulmonary hypertension and right and left sided systolic or diastolic dysfunction, pulmonary specialists in patients with severe lung disease, and geriatricians who are expert in the evaluation of frailty and dementia, as well as medication management in the elderly. Vascular surgeons may be required for complex access and management of vascular complications after the procedure.…”

Διαταραχές Αγωγής Μετά Από Διαδερμική Αντικατάσταση Αορτικής Βαλβίδας

“…Ενδιαφέρον επίσης είναι το γεγονός πως στους 2 ασθενείς που εμφάνισαν πλήρη κολποκοιλιακό αποκλεισμό σχετικά αργά, μετά τη δεύτερη ημέρα, και υποβλήθηκαν σε δεύτερη ηλεκτροφυσιολογική μελέτη, το διάστημα HV αυξήθηκε σημαντικά >60 msec, ενδεικτικό επιδείνωσης της αγωγής. Η υπό του His βλάβη, είτε προϋπάρχουσα είτε εμφανιζόμενη μετεπεμβατικά, δεν ήταν αναστρέψιμη, κάτι που συμβαδίζει με άλλες ηλεκτροφυσιολογικές μελέτες [85][86][87][88][89]. Στους ασθενείς που δεν υποβλήθηκαν σε εμφύτευση βηματοδότη, η δεύτερη ηλεκτροφυσιολογική μελέτη έδειξε σχετικά σταθερά διαστήματα AH και HV.…”