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Conduction delays after transcatheter aortic valve implantation with balloon-expandable prosthesis and high implantation technique

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Abstract

Performing transcatheter aortic valve implantation with high implantation technique, i.e. with an aorto-ventricular ratio > 60/40, reduces the need of permanent pacemaker implantation. Valve calcification and prosthesis oversizing are predictors of permanent pacemaker implantation, but there are no available data on their role when transcatheter aortic valve implantation is performed with an aorto-ventricular ratio > 60/40. The aim of this study was to evaluate the effect of leaflets/annulus calcification and prosthesis oversizing on the incidence of permanent pacemaker implantation after transcatheter aortic valve implantation with a high implantation technique. Transcatheter aortic valve implantation was performed in 48 patients implanting a balloon-expandable transcatheter heart valve with an aorto-ventricular ratio > 60/40. Calcium burden was assessed by preprocedural multidetector computed tomography. An invasive electrophysiological study was performed before and after transcatheter aortic valve implantation. Five patients (10.4%) needed permanent pacemaker implantation. At univariate analysis, baseline right bundle branch block and postprocedural PR, QRS and His-ventricular interval elongation significantly predicted permanent pacemaker implantation (p < 0.05). Receiver-operating characteristic curve analysis showed a correlation between transcatheter heart valve oversizing and permanent pacemaker implantation need, with the best cut-off being 17% (AUC = 0.72, p = 0.033). Linear regression analysis demonstrated that QRS complex elongation was related to total, left and non-coronary leaflet calcification (p < 0.05). This study demonstrates that, when transcatheter aortic valve implantation is performed using a balloon-expandable transcatheter heart valve deployed with an aorto-ventricular ratio > 60/40, the presence of leaflets/annulus calcification or the need to oversize the prosthesis correlate with the occurrence of pathological cardiac conduction delays.

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Acknowledgements

The author Donato Gerardi is currently attending the Cardiopath PhD program. We would like to thank biomedical engineer Giovanna Perrotta, allied professional serving as filed product manager for Biosense Webster Inc, for her precious support at the EP workstation.

Funding

This research was supported from an unrestricted grant from Edwards Lifesciences (I15-220).

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Authors and Affiliations

  1. Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy

    Fortunato Iacovelli, Francesco Loizzi & Stefano Favale

  2. Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy

    Giuseppe Giugliano, Donato Gerardi & Giovanni Esposito

  3. Division of Cardiology, “San Giovanni di Dio” Hospital, Melfi, Italy

    Donato Gerardi

  4. Interventional Cardiology Service, “Montevergine” Clinic, Mercogliano, Italy

    Luigi Salemme, Angelo Cioppa, Armando Pucciarelli, Grigore Popusoi & Tullio Tesorio

  5. Vivasure Medical Ltd, Galway, Ireland

    Giancarlo Schettino

  6. Electrophysiology Service, “Montevergine” Clinic, Mercogliano, Italy

    Francesco Solimene

  7. Division of Cardiology, Cardiovascular Department, “San Carlo” Regional Hospital, Potenza, Italy

    Eugenio Stabile

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  1. Fortunato Iacovelli
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  2. Giuseppe Giugliano
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  3. Donato Gerardi
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  8. Francesco Loizzi
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Correspondence to Fortunato Iacovelli.

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The author Giancarlo Schettino has served as clinical specialist THV for Edwards Lifesciences; the remaining authors have no conflicts of interest to declare.

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Iacovelli, F., Giugliano, G., Gerardi, D. et al. Conduction delays after transcatheter aortic valve implantation with balloon-expandable prosthesis and high implantation technique. Heart Vessels 37, 337–346 (2022). https://doi.org/10.1007/s00380-021-01913-z

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  • DOI: https://doi.org/10.1007/s00380-021-01913-z

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