Related Experiment Videos
Late conduction defects following aortic valve replacement
J M Habicht1, P Scherr, H R Zerkowski
1Department of Surgery, University Hospital, Basel, Switzerland.
Insights
Late cardiac conduction defects (CD) can occur after aortic valve replacement (AVR), even with normal initial ECGs. Regular ECG monitoring is recommended as these defects may appear years after surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Aortic valve replacement (AVR) is a common procedure.
- Cardiac conduction defects (CDs) can occur post-surgery.
- The incidence and timing of late CDs after AVR require further investigation.
Purpose of the Study:
- To determine the incidence of late cardiac conduction defects (CDs) following aortic valve replacement (AVR).
- To assess the clinical significance and timing of these late CDs.
- To evaluate the need for pacemaker implantation in patients developing late CDs.
Main Methods:
- Prospective outpatient evaluation of 100 consecutive patients undergoing AVR.
- Analysis of electrocardiograms (ECGs) to identify perioperative and late cardiac conduction defects.
- Tracking of pacemaker implantation and changes in pre-existing CDs.
Main Results:
- Perioperative mortality was 5%, with 3% requiring perioperative pacemaker implantation.
- 19% of patients had pre-existing CDs; 45% maintained normal ECGs throughout.
- Late CDs, primarily left bundle branch block (LBBB), occurred in 13.7% of survivors with initially normal ECGs, up to 102 months post-AVR.
Conclusions:
- Cardiac conduction defects (CDs) occur with significant incidence late after aortic valve replacement (AVR), irrespective of initial ECG normality.
- While late CDs are common, the need for late pacemaker implantation remains rare.
- Continuous ECG monitoring is crucial for timely detection of late-developing CDs after AVR.
Background And Aim Of The Study:
The study aim was to determine the incidence and clinical significance of late cardiac conduction defects (CD) after aortic valve replacement (AVR).
Methods:
An analysis was made of 100 consecutive cases after AVR in a prospective outpatient evaluation program.
Results:
The perioperative (30-day) mortality rate was 5%, and incidence of perioperative pacemaker implantation 3%. Among patients, 19% had CDs before surgery; a normal ECG was present during all periods in 45% of patients. The most frequent perioperative CD was left anterior hemiblock (LAHB; n = 8), and the most frequent late CD was left bundle branch block (LBBB; n = 8). Overall, 13.7% of operative survivors with normal preoperative and perioperative ECGs developed late CDs; one patient (1%) required pacemaker implantation 82 months after AVR. A further three patients (3%) had worsening of pre-existent CDs. Late CDs occurred over a wide time range (3 to 102 months) after surgery.
Conclusion:
There is an important incidence of CDs that occur late after AVR, even if the perioperative ECGs are normal; however, a need for late pacemaker implantation is rare. As CDs may occur at any time after surgery, regular follow up with precise evaluation of ECGs is called for.