SPC365

De novo conduction disturbances after TAVI: What to expect?

Session: Sessão de Posters 23 - Pacing após TAVI
Speaker: Débora Silva Correia

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Débora da Silva Correia; Maria Rita Lima; Afonso Félix de Oliveira; Rita Barbosa Sousa; Samuel Azevedo; Miguel Domingues; Daniel Gomes; Francisco Albuquerque; Marisa Trabulo; Pedro Adragão; Manuel Sousa Almeida; Rui Campante Teles

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><em><span style="font-family:&quot;Times New Roman&quot;,serif">De novo</span></em><span style="font-family:&quot;Times New Roman&quot;,serif"> conduction disturbances represent the most prevalent complication post-TAVI attributed to conduction system injury. While only a minority of patients with <em>de novo </em>conduction abnormalities require permanent pacemaker implantation (PPI), the consequences and progression of conduction abnormalities in patients without the need for PPI&nbsp;has not been fully characterized. Therefore, we studied TAVI patients without PPI at index hospitalization and <em>de novo</em> conduction abnormalities assessing the rate of PPI at one-year and predictors of conduction system disease progression. &nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">We analysed our prospective single centre registry including 766 consecutive patients undergoing TAVI between January 2014 and August 2021. A total of 109 patients had undergone PPI in index admission and were excluded. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">We defined a cohort of patients with new onset conduction abnormalities, i.e. <em>de novo </em>1<sup>st</sup> degree AV block or <em>de novo </em>left/right bundle brunch block (LBBB and RBBB), without need for PPI at hospital discharge. Baseline data was recorded prospectively, and follow-up data was retrieved using electronic health records. Risk factors for PPI at one year after index hospitalization were assessed using logistic regression. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">The 657pts study population mean age was 83&plusmn; 6 years and 46% were male. A total of 37% had previous RBBB, 11% had previous LBBB, 45% had new onset conduction abnormalities and 55% did not.&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">The median aortic valve calcium score (AVCS) was 2529 [1730-3500] AU. A self-expandable valve was implanted in 459 (71%) patients and 221 (34%) underwent pre-dilation. Transvenous pacing was used and removed in 121 (18%) patients. A total of 89 pts (14%) had prolonged PQ (mean PQ interval at discharge of 196&plusmn;44ms), 150 pts (23%) had new-onset LBBB and 12 pts (2%) new onset RBBB. &nbsp;At 1-year FUP, 15pts (2%) underwent PPI with a mean time interval of 92&plusmn;36 days after TAVI. Among these, 14 had presented <em>de novo</em> conduction abnormalities TAVI (0.3% vs 5%, p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">In the cohort of patients with new onset conduction abnormalities, only the presence of previous RBBB (23% vs 5%, OR 5.746 [1.409-23.431]) and non-sustained complete AV block (57% vs 25%, OR 2.985 [1.077-8.272]) increased the risk of PPI at 1-year in univariate analysis. In multivariate analysis using logistic regression, previous RBBB remained the only predictor of late PPI at 1-year.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">New-onset conduction abnormalities without PPI after TAVI occur in 45% patients and 2% require PPI at one year. Those with previous RBBB warrant a closer surveillance. </span></span></span></p>