0315 : Atrioventricular conduction disturbance after transcatheter aortic valve implantation: incidence and predictive factors

Abstract

Atrioventricular (AV) conduction disturbance leading to pacemaker (PM) implantation is frequent after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and the predictors of PM implantation after TAVI. Between 2010 and 2014, 198 consecutive patients underwent TAVI in our center. 42 patients were excluded from the study because of a pre-existing PM before TAVI. 156 patients (62 Corevalve (CV), 94 Edwards Sapiens valve (ES) were included and prospectively followed during 1 year. Complete AV block occurred after TAVI in 29 patients (19%), second degree AV block in 3 (0.05%), new left bundle branch block (LBBB) in 53 (34%). A PM was implanted in 40 patients (26%). CV patients were more frequently implanted than ES (35% vs 19%; p=0.03). Post-procedure PR, QRS duration were longer in the PM group (227 vs 196ms; 159 vs 129ms, respectively, p<0.001). LBBB was also more frequent (79% vs 53%; p=0.01). At hospital discharge, 83% of the PM group was stimulated. At 1 month, 10% were PM dependent and 4% at 6 months. At 1 month, 29% were stimulated less than 5% of the time and 25% at 6 months. Multivariate analysis showed that the predictors of PM implantation were a pre-existing RBBB (OR 4.7, IC 1.43-15.52, p=0.01), a pre-existing LBBB (OR 7.28, IC 2.34-22.6, p<0.001), a per-TAVI complete AV block (OR 4.21, IC 1.52-11.63, p=0.006), a high prosthesis/annulus diameter ratio (OR 1.1, IC 1.04-1.18, p=0.003) and postprocedure PR and QRS long duration (OR 1.03, IC 1.01-1.06, p=0.009; OR 1.04, IC 1.01-1.07, p=0.009 respectively). PM implantation had no impact on survival after TAVI (Logrank=0.92). The increase in LVEF post-TAVI was lower in PM group: 0.2 vs 8%, p=0.05 at 6 months and -5 vs 9.6%, p=0.004 at 1 year. The NYHA class was similar in both groups at follow up. TAVI is associated in a great proportion of patients with AV disturbances which are mostly regressive over time. Patients with pre-existing RBBB, LBBB and high prosthesis/annulus diameter ratio are at increased risk of complete AV block. LVEF increase was lower in PM group even with a low percentage of stimulation time.