Time Course and Risk Factors of New-Onset Complete Atrioventricular Block After Transcatheter Aortic Valve Implantation

Abstract

In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.

The Impact of Surgical versus Transcatheter Aortic Valve Replacement on Postprocedural Acute Kidney Injury in Patients with Chronic Kidney Disease

“…Although a higher risk of advanced conduction abnormalities, including new-onset left bundle branch block and high-grade atrio-ventricular block requiring pacemaker assistance, after TAVR than after SAVR has been well demonstrated in previous studies [ 23 , 24 ], the PPM insertion rate of 14.3% in the TAVR group was relatively high considering recent studies reporting PPM insertion rates of 4.0% to 12.7% [ 25 , 26 ]. In addition, a previous study at our institution reported that 5.8% of 206 patients underwent PPM insertion after a TAVR procedure [ 27 ]. This might be attributed to the fact that patients with CKD have a high burden of calcium in the cardiovascular system including a diseased aortic valve [ 28 ], which is vulnerable to conduction block after the TAVR procedure.…”