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Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation
Author(s) -
van der Boon Robert M.A.,
Houthuizen Patrick,
Urena Marina,
Poels Thomas T.,
van Mieghem Nicolas M.,
Brueren Guus R.G.,
Altintas Sibel,
Nuis Rutger Jan,
Serruys Patrick W.,
van Garsse Leen A.F.M.,
van Domburg Ron T.,
Cabau Joseph Rodés,
de Jaegere Peter P.T.,
Prinzen Frits W.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25765
Subject(s) - medicine , cardiology , left bundle branch block , univariate analysis , logistic regression , multivariate analysis , permanent pacemaker , heart failure
Objectives The aim of the study was to investigate trends over time in the occurrence of left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve System (MCS) and Edwards SAPIEN Valve (ESV). Background : TAVI‐induced conduction abnormalities (TAVI‐CAs) such as LBBB and the need for PPI are frequent postoperative complication. New techniques, procedural refinements, and increased awareness are focused on the reduction of these abnormalities. Methods Electrocardiograms of 549 patients without preprocedural LBBB and/or pacemaker were assessed to determine the frequency and nature of TAVI‐CAs. To study the effect of experience, patients were subdivided per center into tertiles based on the number of procedures. Univariate and multivariate logistic regression was used to study predictors of TAVI‐induced LBBB (TAVI‐LBBB) and PPI. Results TAVI‐LBBB occurred in 185 patients (33.7%) and significantly decreased over time, from 42.6% to 27.3% ( P = 0.006). This effect was only significant after implantation of the MCS (59.6% vs. 46.5% vs. 31.1%, P = 0.001, ESV: 22.6% vs. 13.1% vs. 24.8%, P = 0.11). Between tertiles there was no difference in the frequency of PPI after TAVI ( n = 73, 13.1% vs. 14.8% vs. 12%, P = 0.74). Multivariate analysis revealed that, independent from valve type, depth of implantation was the only significant predictor of TAVI‐LBBB (OR [95% C.I.]: 1.16 [1.10–1.24], P < 0.001). In case of PPI pre‐existing RBBB (OR [95% C.I.]: 7.22 [3.28–15.88], P < 0.001) was the only significant predictor. Conclusions Over time the frequency of LBBB after TAVI decreased significantly, especially in patients undergoing TAVI with the MCS. Experience and the subsequent reduction in depth of implantation seem responsible for this reduction. Contrary to TAVI‐LBBB, the incidence of PPI remained unchanged over time and was not affected by experience. Although experience has led to a decrease in new CAs after TAVI, elucidation of pathophysiologic mechanisms underlying these CAs and subsequent changes in patient stratification, valve design and the procedure are needed to further reduce this complication. © 2014 Wiley Periodicals, Inc.