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Conduction Disturbances after TAVI - Real-Life Data from a Portuguese Center
Session:
Sessão de Comunicações Orais - Doença Valvular
Speaker:
Miguel Martins de Carvalho
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Miguel Martins De Carvalho; Tânia Proença; Ricardo Alves Pinto; Catarina Martins Costa; Sofia Torres; Carlos Xavier Resende; Pedro Grilo Diogo; Ana Amador; João Calvão; Alzira Nunes; Paulo Maia Araújo; Roberto Pinto; Marta Tavares Silva; Gonçalo Pestana; Silvia Oliveira; Raquel Mota Garcia; Ana Margarida Lebreiro; Luís Adão; JOAO SILVA; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction</strong>: Transcatheter aortic valve implantation (TAVI) is an established procedure to treat patients (pts) with symptomatic severe aortic stenosis. Despite major improvements, the occurrence of conduction disturbances has not decreased over time and remains the most frequent complication.</p> <p><strong>Purpose</strong>: To describe and evaluate new conduction disturbances in pts undergoing TAVI.</p> <p><strong>Methods</strong>: We retrospectively analyzed all pts who underwent TAVI at a tertiary Portuguese center from October 2014 to November 2019 (n=371); pts with a previous pacemaker (PM) was excluded (n=30). A pre- and post-procedure ECG was performed; clinical and ECG data was collected at presentation and up to 6 months after implantation.</p> <p><strong>Results</strong>: 341 pts underwent TAVI (57% female, mean age 81±8years). CoreValve Evolut R was used in 41.1% of cases, followed by CoreValve Evolut Pro (21.1%), Acurate Neo (12.9%), Edwards SAPIEN 3 (9.7%), Portico (9.1%), CoreValve (4.1%) and LOTUS (2.1%). 72% of pts were in sinus rhythm pre-TAVI, 22% in atrial fibrillation; 59% had normal atrioventricular (AV) conduction, 15% had 1<sup>st</sup> degree AV block (AVB); 55% had no intraventricular (IV) conduction disturbance, 8% had left bundle branch block (LBBB), 7% had right bundle branch block (RBBB), 6% had a RBBB plus fascicular block, 7% had left anterior fascicular block and 9% had nonspecific intraventricular conduction delay (NICD). During hospitalization 50.1% of pts exhibited de novo conduction disturbance, both AV (25.9%, p<0.001) and IV (34.8%, p<0.001). Regarding AV conduction, 20% of pts without previous disturbances developed 1<sup>st</sup> degree AVB and 9% advanced AVB; 9% of pts with previous 1<sup>st</sup> degree AVB developed advanced AVB. Concerning IV conduction, 30% of pts maintained normal conduction after the procedure, 38% were in LBBB, 6% RBBB, 7% RBBB plus fascicular block and 7% NICD. In pts with previous RBBB, 42% developed advanced AVB and 44% implanted PM; the presence of previous RBBB was a major risk factor for advanced AVB [OR=8.5 (95% CI 4.0-17.6; p<0.001)] and PM implantation [OR=5.2 (95% CI 2.7-10.0; p<0.001)]. At 6 months follow-up, 55% of new IV conduction disturbances resolved; <em>de novo</em> LBBB resolved in 56% of pts and fascicular block in 75%.</p> <p><strong>Conclusion</strong>: LBBB was the most frequent IV conduction disturbance after TAVI, but a significant proportion of cases resolved during follow-up. As reported in the literature, RBBB was a major risk factor for advanced AVB and PM implantation after TAVI in our population.</p>
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