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Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis.

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2022-05-10

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Castro-Mejía, Alex F
Amat-Santos, Ignacio
Ortega-Armas, Maria E
Baz, Jose A
Moreno, Raúl
Diaz, Jose F
Travieso, Alejandro
Jimenez-Quevedo, Pilar
Santos-Martínez, Sandra
McInerney, Angela

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Abstract

High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR. Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p  New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.

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MeSH Terms

Aortic Valve
Aortic Valve Stenosis
Cardiac Conduction System Disease
Heart Valve Prosthesis
Humans
Prosthesis Design
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome

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Keywords

Electrocardiographic disturbances, Pacemaker, Self-expanding aortic valves, Transcatheter aortic valve replacement

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