scholarly journals Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Oscar A. Mendiz ◽  
Marko Noč ◽  
Carlos M. Fava ◽  
Luis Abel Gutiérrez Jaikel ◽  
Matias Sztejfman ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Common Complication ◽  
Surgical Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Baseline Characteristics ◽  
Low Volume ◽  
New Onset

Background and Aim. Conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication for TAVR procedures, particularly when self-expanding valves are used. We compared the 30-day incidence of new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPMI) rate between two consecutive groups using either conventional 3-cusp coplanar view (CON) and right/left cusp-overlap view (COVL) for implantation. Methods and Results. We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p = 0.05 ) and PPMI rate (17.8% vs. 6.4%; p = 0.004 ) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). Conclusion. Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.

scholarly journals Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1244-1251 ◽  
Author(s):  
Nynke H M Kooistra ◽  
Martijn S van Mourik ◽  
Ramón Rodríguez-Olivares ◽  
Alexander H Maass ◽  
Vincent J Nijenhuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Pacemaker Implantation ◽  
Early Discharge ◽  
Permanent Pacemaker ◽  
Conduction Delay ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Timing Of Onset

BackgroundThe timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.Methods and resultsWe performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.ConclusionsSafe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.

scholarly journals Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report

2020 ◽  
Author(s):  
Markus Bettin ◽  
Matthias Koopmann ◽  
Gerold Mönnig ◽  
Christian Pott
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Sudden Cardiac Arrest ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
Permanent Pacemaker Implantation ◽  
Idioventricular Rhythm

Abstract Background Accelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF). Case summary A 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death. Discussion Delayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.

scholarly journals Use of Electrophysiological Studies in Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 9 (1) ◽  
pp. 20-27
Author(s):  
Oholi Tovia-Brodie ◽  
Yoav Michowitz ◽  
Bernard Belhassen
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Transcatheter Aortic Valve ◽  
Electrophysiological Studies ◽  
Aortic Valve Implantation ◽  
Valve Implantation

New conduction disturbances requiring permanent pacemaker implantation remain common complications following transcatheter aortic valve implantation (TAVI). It has been suggested that electrophysiological studies could help identify patients who will require permanent pacemaker implantation after TAVI. This article summarises contemporary data on the use of electrophysiological studies in patients undergoing TAVI.

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