PO-04-002 AN ELECTROPHYSIOLOGICAL STUDY OF CONDUCTION SYSTEM DISTURBANCES IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT

Abstract

Conduction system disturbances are common in aortic valve replacement cases. Several studies have been done for electrophysiological assessment of conduction system abnormalities in patients undergoing transcatheter aortic valve replacements, however, there is hardly any electrophysiological study to assess conduction system disturbances in patients undergoing isolated surgical aortic valve replacements. To determine the electrocardiographic and electrophysiologic changes in patients undergoing isolated surgical aortic valve replacement. This is a single-centre open labelled observational study, it included thirty eight patients aged more than forty five years with isolated severe aortic valve stenosis posted for coronary workup prior to valve replacement surgery. Enrolled patients at the time of coronary angiogram underwent a single catheter electrophysiology study via six french right femoral venous sheath to assess the AH and HV intervals. The same study was repeated in the post operative period prior to discharge. In this study of thirty eight patients, there was no difference in AH and HV intervals pre and post procedure. AH interval difference in median pre and post procedure was 5 milliseconds (74milliseconds versus 79milliseconds), showing a weak association (p value = 0.012). HV interval difference in median pre and post procedure was 0.5 milliseconds (47.5 milliseconds vs 48 milliseconds),showing no association (p value = 0.542). There were no electrocardiographic changes post procedure. One patient with baseline right bundle branch block with normal HV interval developed prolonged HV interval of 75 milliseconds post procedure and required pacemaker at follow up. The same patient had severe calcification of aortic valve extending upto the septum. In this first study comparing the findings of electrophysiologic study and electrocardiography, the impact of isolated aortic valve replacement on the cardiac conduction system showed not much perturbance of conduction system by surgical aortic valve replacement.Tabled 1Electrophysiological study parameters before and after procedureElectrophysiology study intervalPre procedurePost procedurep value*RangeMedian (IQR)RangeMedian (IQR)AH interval (milliseconds)45 - 14274 (22.2)55 - 13079 (23)0.012HV interval (milliseconds)32 - 5847.5 (9.75)38 - 7148 (8)0.542*Wilcoxon signed rank test for non-parametric distribution Open table in a new tab