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Conduction disorders using the Evolut R prosthesis compared with the CoreValve: has anything changed?

Nils Perrin1, Tilman Perrin1, Anne-Lise Hachulla2

  • 1Cardiology Division, University Hospital of Geneva, Geneva, Switzerland.

Open Heart
|April 11, 2018
PubMed
Summary

The new Evolut R prosthesis caused more conduction delays after TAVI than the CoreValve system. However, both devices showed similar rates of high-degree heart block and pacemaker implantation up to six months.

Keywords:
atrio-ventricular delayconduction disordershigh-degree atrio-ventricular blockleft bundle branch blocktranscatheter aortic valve implantation

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Transcatheter aortic valve implantation (TAVI) is a key treatment for severe aortic stenosis.
  • Understanding the impact of different TAVI prostheses on cardiac conduction is crucial for patient outcomes.

Purpose of the Study:

  • To compare early and midterm conduction disorders after implantation of the Evolut R (ER) versus the CoreValve (CV) system.
  • To evaluate the evolution of atrioventricular and intraventricular conduction up to 6 months post-TAVI.

Main Methods:

  • Retrospective analysis of ECGs from patients undergoing TAVI with ER or CV self-expanding devices.
  • ECGs were analyzed at baseline, day 1, discharge, and 6 months post-TAVI.
  • Comparison of conduction parameters including PR interval, QRS duration, and heart block incidence between the two prosthesis groups.

Main Results:

  • Patients receiving the ER prosthesis showed significantly more postprocedural PR interval and QRS prolongation at discharge compared to the CV group.
  • The incidence of complete atrioventricular block was similar between the ER and CV groups (9% vs 18%, P=0.3).
  • No significant differences were observed in new left bundle branch block (34% vs 28%, P=0.8) or permanent pacemaker implantation rates (32.1% vs 31.7%, P=1.0) between the groups up to 6 months.

Conclusions:

  • The Evolut R prosthesis is associated with greater early postprocedural atrioventricular and intraventricular conduction delays compared to the CoreValve system.
  • Despite initial conduction delays, midterm outcomes regarding high-degree atrioventricular block, new left bundle branch block, and pacemaker implantation rates were similar for both devices.