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Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic

Jan Baan1, Ze Yie Yong, Karel T Koch

  • 1Department of Cardiology and Cardio-thoracic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. j.baan@amc.nl

American Heart Journal
|March 10, 2010
PubMed

Insights

Percutaneous aortic valve implantation (PAVI) with the CoreValve prosthesis leads to a high rate of atrioventricular block requiring permanent pacemaker implantation (PPI) and new left bundle-branch block (LBBB). Factors like narrow outflow tracts and mitral calcification predict PPI need.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Cardiac conduction disorders and permanent pacemaker implantation (PPI) are common after surgical aortic valve replacement.
  • Percutaneous aortic valve implantation (PAVI) is an alternative procedure with its own risk profile.
  • Understanding conduction disturbances post-PAVI is crucial for patient management.

Purpose of the Study:

  • To determine the incidence of cardiac conduction disorders after PAVI using the CoreValve prosthesis.
  • To identify clinical factors associated with the development of these conduction disorders.
  • To evaluate the need for PPI and new-onset left bundle-branch block (LBBB) post-PAVI.

Main Methods:

  • A study of 34 patients undergoing PAVI with the CoreValve bioprosthesis.
  • Pre- and postprocedural electrocardiographic (ECG) evaluation at 1-week and 1-month follow-up.
  • Analysis of clinical variables including medical history, echocardiography, and angiography.

Main Results:

  • Seven patients (20.6%) required PPI, all developing total atrioventricular block within 3 days.
  • Factors associated with PPI included smaller left ventricular outflow tract diameter, more left-sided heart axis, severe mitral annular calcification, and smaller postimplantation indexed effective orifice area.
  • The incidence of new LBBB was 65%, associated with deeper prosthesis implantation.

Conclusions:

  • PAVI with the CoreValve prosthesis is associated with a high incidence of total atrioventricular block requiring PPI and new-onset LBBB.
  • Preexisting conduction disturbance, narrow left ventricular outflow tract, and mitral annular calcification predict the need for PPI.
  • Prosthesis implantation depth is the sole predictor for new-onset LBBB.
Abstract

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