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Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter

Tsung-Yu Ko1,2, Hsien-Li Kao3, Ying-Ju Liu4

  • 1Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.

Scientific Reports
|August 19, 2021
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) can cause conduction disturbances (CD). Patients without CD after TAVR show improved heart function and sustained LV mass regression over three years, unlike those with CD.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
  • Conduction disturbances (CD), including new left bundle branch block and permanent pacemaker implantation, are known complications following TAVR.
  • The impact of post-TAVR CD on left ventricular (LV) mass regression and remodeling remains incompletely understood.

Purpose of the Study:

  • To compare left ventricular (LV) mass regression and remodeling in patients with and without conduction disturbances (CD) after transcatheter aortic valve replacement (TAVR).
  • To assess the long-term effects of post-TAVR CD on cardiac structure and function.

Main Methods:

  • Prospective analysis of 152 consecutive TAVR patients.
  • Categorization of patients into groups with and without CD (permanent pacemaker implantation or new left bundle branch block).
  • Evaluation of LV ejection fraction (LVEF), LV end-systolic volume (LVESV), and LV mass index at baseline, 12 months, and 36 months.

Main Results:

  • 53 patients (34.9%) developed CD post-TAVR.
  • At 1-year follow-up, patients without CD showed significant improvement in LVEF and reduced LVESV, whereas patients with CD did not.
  • Both groups exhibited LV mass index decrease at 1 year, but only the non-CD group demonstrated sustained significant LV mass regression at 3 years.

Conclusions:

  • Post-TAVR conduction disturbances are associated with impaired left ventricular remodeling and systolic function recovery.
  • Patients without conduction disturbances following TAVR experience significant LV mass regression at 1 year, with sustained regression observed up to 3 years.
  • These findings highlight the importance of monitoring and managing conduction disturbances after TAVR for optimal cardiac recovery.

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