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The timing and mechanism of high-grade AV block post-TAVI: Knowing your enemy
Session:
CO 24 - Interventional Cardiology -TAVI
Speaker:
Daniel A. Gomes
Congress:
CPC 2021
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:
Daniel A. Gomes; Afonso Félix Oliveira; Rui Campante Teles; Francisco Gama; Pedro Carmo; João Brito; Pedro de Araújo Gonçalves; Diogo Cavaco; Manuel de Sousa Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black"><strong>Background: </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black">Complete atrioventricular block (AVB) requiring permanent pacemaker implantation (PPMI) is still a major limitation of transcatheter aortic valve implantation (TAVI) procedures. Although right-bundle branch block (RBBB), membranous septum (MS) length and self-expandable prothesis are recognizable risk factors, their predictability to PPMI is far from satisfactory. While some patients (pts) develop persistent intra-procedure high-grade AVB (H-AVB), others present much later with severe bradycardia. This study aims to describe and compare the characteristics of pts who develop AVB during or after TAVI.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black"><strong>Methods: </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black">Single centre prospective registry of 506 consecutive pts submitted to TAVI with no previous pacemaker between 2017 and 2020. Post-procedure PPMI (up to 30 days after discharge) was studied and divided into two groups according to the development of persistent intra-procedure H-AVB (Group A) or post-procedure H-AVB (Group B). Baseline ECG, computed tomography and TAVI-related characteristics were analyzed. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black"><strong>Results: </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black">A total of 88 pts (17,3%), aging 83±6 years, 36.4% male, underwent post-TAVI PPMI (6 after discharge). Previous conduction disturbances were present in 50 (56.8%) pts and 25 (28.4%) had RBBB. 83% were submitted to self-expandable TAVI. 42 (47.7%) pts had persistent intra-procedure H-AVB (Group A) whereas 52.3% had post-procedure H-AVB (Group B). In pts with persistent intra-procedure H-AVB p<span style="color:black">revious RBBB was significantly more frequent (45.2%, n=19) when compared to pts with post-procedure H-AVB (13%, n=6; p=0.001). Contrarily, AF and previous left-bundle branch block (LBBB) were more likely in Group B. No difference in valvular calcification, MS length, prosthesis type or implantation technique was noted (table 1). In the group with post-procedure H-AVB, 21.7% had transient AVB during TAVI and all developed <em>de novo</em> LBBB or first-degree AVB post-TAVI.</span> Among these, 33 (71.7%) pts developed delayed H-AVB (> 48h post-procedure) while the remaining presented earlier. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black"><strong>Conclusions:</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black">In pts with PPMI post-TAVI, those with persistent intra-procedure H-AVB had higher rates of previous RBBB, while those with post-procedure H-AVB frequently had a<em> </em>normal baseline ECG. Anatomical and procedural characteristics did not differ between groups. Further studies are needed to confirm these results.</span></span></span></p>
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