scholarly journals The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement

2020 ◽  
Vol 9 (6) ◽  
pp. 452-467
Author(s):  
Shmuel Chen ◽  
Katherine H. Chau ◽  
Tamim M. Nazif
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cardiac Conduction ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve

scholarly journals Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

2015 ◽  
Vol 04 (2) ◽  
pp. 81 ◽  
Author(s):  
Mark Young Lee ◽  
Srinath Chilakamarri Yeshwant ◽  
Sreedivya Chava ◽  
Daniel Lawrence Lustgarten ◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Block ◽  
Transcatheter Aortic Valve Replacement ◽  
Permanent Pacemaker ◽  
Cardiac Conduction ◽  
Clinical Predictors ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve

Transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option in patients with symptomatic severe aortic stenosis at prohibitive or increased risk for conventional surgical replacement. Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of this review. Atrioventricular conduction disturbances and arrhythmias before, during or after TAVR remain a matter of concern for this high-risk group of patients, as they have important consequences on hospital duration, short- and long-term medical management and finally on decisions of device-based treatment strategies (pacemaker or defibrillator implantation). We discuss the mechanisms of atrioventricular disturbances and characterise predisposing factors. Using validated clinical predictors, we discuss strategies to minimise the likelihood of creating permanent high-grade heart block, and identify factors to expedite the decision to implant a permanent pacemaker when the latter is unavoidable. We also discuss optimal pacing strategies to mitigate the possibility of pacing-induced cardiomyopathy.

scholarly journals Anatomical Predictors of Pacemaker Dependency after Transcatheter Aortic Valve Replacement

2020 ◽  
Author(s):  
Luca Nai Fovino ◽  
Alberto Cipriani ◽  
Tommaso Fabris ◽  
Mauro Massussi ◽  
Andrea Scotti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow

Background - Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to PM dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker (PM) dependency after transcatheter aortic valve replacement (TAVR). Methods - Consecutive patients undergoing PM implantation up to 30-day after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography and procedural characteristics were collected, including valve implantation depth (ID) and membranous septum (MS) length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. PM dependency at 30-day and 1-year and all-cause mortality during follow up were evaluated. Results - Of 728 TAVR patients, 112 (53.5% males, median age 81) underwent PM implantation after TAVR. Of these, 44.6% (50/112) were PM-dependent at 30-day, 46.7% (36/77) at 1-year. By multivariate analysis, independent predictors of 30-day PM dependency included left ventricular outflow tract (LVOT) calcifications under the left coronary cusp (LCC) (OR: 5.69, 95%CI: 1.45-22.31, p=0.013) and a difference between MS length and ID (ΔMSID) ≥3 mm (OR: 7.58, 95%CI: 2.07-27.78, p=0.002). Conversely, MS length and ID alone were not associated with PM dependency (OR: 0.79, 95%CI: 0.60-1.05, p=0.11 and OR: 1.11, 95%CI: 0.99-1.24, p=0.08). At a median follow-up of 28.1 [11.7-48.6] months, PM-dependent patients did not show a worse survival (p=0.26). Conclusions - Less than half of the patients undergoing PM implantation after TAVR are PM-dependent at mid-term follow-up. ΔMSID ≥3mm and presence of LVOT calcifications under the LCC, but not MS length nor ID alone, are predictive of long-term PM dependency after TAVR, thus influencing device selection and programming.

Abstract 13908: Prevalence and Implications of Junctional Rhythm During Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Natthapon Angsubhakorn ◽  
Maria Anderson ◽  
Baris Akdemir ◽  
Stefan C Bertog ◽  
Santiago Garcia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Case Series ◽  
Cardiac Conduction ◽  
Ventricular Rate ◽  
P Waves ◽  
Junctional Rhythm ◽  
Transcatheter Aortic Valve

Introduction: Cardiac conduction abnormalities are among the most frequent complications of transcatheter aortic valve replacement (TAVR). A small case series has raised the possibility that junctional rhythm (JR) following TAVR may be associated with poor outcomes. However, the prevalence and implications of JR during TAVR have not been systematically studied. Methods: We retrospectively reviewed intra-procedural continuous 6-lead telemetry of 300 consecutive patients undergoing TAVR between April 2015 and April 2019 to identify JR that occurred after deploying the valve . Forty-two patients with pre-existing permanent pacemaker (PPM) were excluded. JR was defined as regular rhythm without P waves but with QRS morphology that was identical to baseline. Results: A total of 258 patients fulfilled the inclusion criteria (mean age of 77.5±8.5 years and 99% men). During TAVR, 79 (30.6%) patients developed new JR. The mean ventricular rate was 74.6±31.0 bpm. Patients who developed JR had similar baseline characteristics compared to those without JR (Table). After TAVR, 57 (22.1%) patients required PPM for complete atrioventricular block. There was a trend for a higher rate of PPM implantation in patients with rapid JR (39%) vs. slow JR (26%) vs. no JR (19.0%, p=0.10). In logistic regression analysis, patients who had a rapid JR (rate >100 bpm) were 2.71 times (95% CI 0.98-7.52, p=0.055) more likely to require PPM than those without JR. Conclusions: Junctional rhythm after deploying the valve is common in TAVR. There was a trend for higher PPM implantation risk among patients who developed rapid JR. Further investigation of these observations in larger cohorts is needed.

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