Abstract 8171: Invasive Assessment of Atrioventricular Conduction Changes Following Transcatheter Aortic Valve Implantation with Self-expandable or Balloon-Expandable Prosthesis

Abstract

Background: Atrio-ventricular block (AVB) is one of the complications after transcatheter aortic valve implantation (TAVI), and is more frequent after implantation of a Medtronic CoreValve (MCV) than after implantation of an Edwards Sapien prosthesis (ES). The aim of this prospective study was to quantify and compare by invasive measurement the exact influence of TAVI with MCV or ES valve on atrioventricular conduction. Methods: between February 2010 and March 2011, consecutive patients who underwent TAVI with a MCV or an ES valve were included in this prospective, single center study. The His-Ventricle (HV) interval was measured during an electrophysiology study (EPS) before and at least 4 days after the procedure. Patients with pre-existent permanent PM implanted for AVB were excluded Results: 60 patients were included. 25 (42%) were treated with a MCV, and 35 (58%) with an ES valve. Mean age was 83±6 years, 62% men with no significant difference of baseline clinical, ECG, echocardiographic data, Logistic EuroScore and STS Score between MCV and ES groups. There was no peri-procedural death. HV interval measurement was feasible in all patients. 19 patients (32%) needed implantation of a permanent PM. Indication was persistent complete AVB in 12 patients (20%) and transient high grade AVB in 4 patients (7%). PM implantation was required in 6 patients (17%) with ES valve and 13 patients (52%) with MCV (Odds Ratio: 6.8, [95% CI 1.9-24.8] p<0.01). HV interval remained stable (increased duration ≤5ms) in 10 patients (30%) with ES valve and in 5 patients (20%) with MCV (p: 0. 15). HV interval was prolonged by 10ms or more after procedure in 12 patients (35%) with ES valve and in 17 patients (68%) with MCV (Odds Ratio: 5. [95% CI 1. 5-16.9] p<0.01). Conclusion: This study supports the fact that atrioventricular and particularly infrahisian conductive tissue is frequently impaired after TAVI. This damage is more frequent and more severe with MCV compared with ES valve.