Impact of PR interval prolongation on the risk of high-grade conductive disorders after transcatheter aortic valve implantation

High grade AV block and consecutive pacemaker (PM) implantation are frequent complications following transcatheter aortic valve implantation (TAVI). We aimed to identify risk factors predicting these complications. For logistic regression analysis, we included 85 patients (mean age 81±7y, EuroScore 24±15%) who underwent TAVI (n=73 transfemoral, n=2 via subclavian artery, n=10 transapical) between June 2007 and May 2008 and who had no previously implanted PM. Of those, 22 (26%) developed postoperative AV block with the need of PM implantation. PM implantation had to be performed more frequently in patients with pathological preoperative ECG findings, such as AV block °I (33% PM implantation) or bundle branch block (39% PM implantation) vs normal ECG (20% PM implantation, n.s.), and in patients receiving a CoreValve (28% PM implantation) vs an Edwards Sapien prosthesis (10% PM implantation, n.s.). Stepwise logistic regression analysis revealed the occurrence of a transient AV block > °I during the TAVI procedure (52% PM implantation) as the only significant independent factor predicting later PM implantation (OR 8.98, CI 2.69 –29.98, p<0.001), while gender, age, EuroScore, prosthesis type and dimensions, annulus diameter and preoperative ECG findings had no significant influence. Patients who experience a transient AV block > °I during TAVI procedures should carefully be monitored postoperatively, as there is a 9fold increased risk of developing high grade AV block with the indication for a PM implantation.

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Fast pathway ablation for atrioventricular nodal reentrant tachycardia with a marked PR interval prolongation during sinus rhythm following transcatheter aortic valve implantation

Clinical Research in Cardiology ◽

10.1007/s00392-014-0685-3 ◽

2014 ◽

Vol 103 (6) ◽

pp. 495-498 ◽

Cited By ~ 2

Author(s):

Christopher Reithmann ◽

Michael Fiek

Keyword(s):

Aortic Valve ◽

Sinus Rhythm ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Interval Prolongation ◽

Reentrant Tachycardia ◽

Transcatheter Aortic Valve ◽

Pr Interval ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Fast Pathway

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Conduction Abnormalities after Transcatheter Aortic Valve Implantation and Diastolic Dysfunction

Cardiology ◽

10.1159/000452706 ◽

2016 ◽

Vol 137 (1) ◽

pp. 36-42

Author(s):

Ofir Priesler ◽

Simon Biner ◽

Ariel Finkelstein ◽

Yoav Michowitz

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Systolic Pulmonary Artery Pressure ◽

Transcatheter Aortic Valve ◽

Conduction Abnormalities ◽

Pr Interval ◽

Diastolic Properties ◽

Aortic Valve Implantation ◽

Valve Implantation

Objectives: Transcatheter aortic valve implantation (TAVI) is frequently associated with the development of conduction abnormalities. We assessed the effect of conduction abnormalities on diastolic function following TAVI. Methods: In total, 101 consecutive post-TAVI patients were included, each with echocardiographic follow-up at 1 and 6 months. Diastolic properties were correlated with the occurrence of a long PR interval and wide QRS, and their change from baseline. The measured diastolic parameters included E/A ratio, E wave deceleration time, E wave to e′ ratio, left atrial (LA) volume, and systolic pulmonary artery pressure (SPAP). The clinical outcome was all-cause mortality. Results: Overall, TAVI was associated with a consistent decrease in SPAP at the 1- and 6-month follow-up. LA volumes were increased at 1 month post-TAVI in patients with a wide compared to normal QRS (p = 0.03) and at 6 months in patients with a normal compared to prolonged PR (p = 0.03). PR prolongation above 40 ms was associated with lower SPAP at the 1- but not 6-month follow-up. Survival was not influenced by conduction abnormalities. Conclusions: TAVI is associated with a reduction in SPAP. A postprocedural wide QRS and normal PR interval may unfavorably influence the left-sided filling performance, resulting in an increased LA volume. Other diastolic parameters, as well as survival, are not significantly affected by postprocedural conduction abnormalities.

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