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Transient and persistent conduction abnormalities following transcatheter aortic valve replacement with the Edwards-Sapien prosthesis: a comparison between antegrade vs. retrograde approaches

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Electrocardiographic conduction abnormalities following transcatheter aortic valve replacement (TAVR) with the Edwards-Sapien valve (ESV) are not uncommon and may be transient. We sought to examine the clinical time-course of conduction abnormalities after TAVR with ESV and determine risk factors for persistent abnormalities.

Methods

In this single-center prospective study, 116 consecutive patients underwent implantation of the ESV after approval by the Food and Drug Administration (FDA). Demographic, clinical, and intra-procedural variables were collected in a registry, including ECGs before, immediately after, and at discharge from hospital. Conduction abnormalities were analyzed including PR interval lengthening, QRS widening, left bundle branch block (LBBB), and high-grade AV block.

Results

There were 92 patients included in the analysis. A total of 41 new conduction abnormalities were observed in 31 (34 %) patients: 7 new PR prolongation, 14 QRS widening, 14 new LBBB, and 5 high-grade AV block requiring permanent pacemaker. Of the 41 new CAs, 11 (27 %) were transient; of the transient abnormalities, 9 (82 %) resolved within 24 h of the index procedure. Chronic kidney disease was a risk factor for the development of a persistent abnormality and for need for PPM. Antegrade approach was associated with the development of persistent LBBB and persistent QRS widening.

Conclusions

A significant proportion of conduction abnormalities after ESV implantation improved prior to discharge from the hospital, usually within 24 h. CKD is associated with persistence of abnormalities and with need for PPM. Antegrade approach increases risk for new intraventricular conduction delays, including LBBB.

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Abbreviations

ECG:

Electrocardiogram

TAVR:

Transcatheter aortic valve replacement

PPM:

Permanent pacemaker

LBBB:

Left bundle branch block

LAFB:

Left anterior fascicular block

POD:

Post-operative day

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Author notes

    Authors and Affiliations

    1. Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA

      Solomon J. Sager, Abdulla A. Damluji, Joshua A Cohen, Sachil Shah, Carlos E. Alfonso, Claudia A. Martinez, Robert J. Myerburg, Alan W. Heldman, Mauricio G. Cohen, Donald B. Williams & Roger G. Carrillo

    2. Cardiac Electrophysiology, Chicago Cardiology Institute, 7035 W. North Ave, Oak Park, IL, 60302, USA

      Solomon J. Sager

    3. Division of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA

      Brian P. O’Neill

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    1. Solomon J. Sager
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    Correspondence to Solomon J. Sager.

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    All other authors have no conflict of interest.

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    Solomon J. Sager and Abdulla A. Damluji contributed equally to this work.

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    Sager, S.J., Damluji, A.A., Cohen, J.A. et al. Transient and persistent conduction abnormalities following transcatheter aortic valve replacement with the Edwards-Sapien prosthesis: a comparison between antegrade vs. retrograde approaches. J Interv Card Electrophysiol 47, 143–151 (2016). https://doi.org/10.1007/s10840-016-0145-2

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    • DOI: https://doi.org/10.1007/s10840-016-0145-2

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