Related Experiment Video

Updated: Aug 13, 2025

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
06:59

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

Published on: June 3, 2018

10.7K

Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement

Valérie Pavlicek1, Felix Mahfoud2, Katharina Bubel3

  • 1Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Saarland University, Kirrberger Str, 66421, Homburg/Saar, Germany. valerie.pavlicek@uks.eu.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|January 21, 2023
PubMed

Insights

New-onset left bundle branch block (BBB) and diabetes mellitus predict high-degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR). Electrophysiologic studies are not needed to identify patients at risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for severe aortic stenosis.
  • Intraventricular conduction disturbances (ICA), including left bundle branch block (BBB) and high-degree atrioventricular block (HAVB), are known complications of TAVR.
  • Predicting and managing these conduction disturbances is crucial for patient outcomes.

Purpose of the Study:

  • To identify clinical, anatomical, procedural, and electrophysiological predictors of ICA after TAVR.
  • Specifically, to investigate factors predicting HAVB requiring permanent pacemaker (PPM) implantation.
  • To evaluate the utility of electrophysiologic studies (EPS) in predicting HAVB post-TAVR.

Main Methods:

  • A prospective study of 203 patients with severe aortic stenosis undergoing TAVR with either self-expanding or balloon-expanding valves.
  • Assessment of clinical and anatomical parameters, including membranous septum length and implantation depth.
  • Measurement of His-ventricular interval (HVi) before and after TAVR.
  • Analysis of 12-lead electrocardiograms (ECG) at baseline and follow-up (3 and 30 days) for ICA detection.

Main Results:

  • TAVR caused significant infranodal conduction prolongation in all patients.
  • Fifteen patients (7%) developed HAVB requiring PPM, and 63 patients (31%) developed ICA within 30 days.
  • Pre-existing BBB, new-onset left BBB, and diabetes mellitus were independent predictors of HAVB requiring PPM. HVi prolongation was not predictive.

Conclusions:

  • New-onset left BBB and diabetes mellitus are independent predictors of HAVB requiring PPM after TAVR.
  • These factors can help identify patients at higher risk for conduction disturbances.
  • Electrophysiologic studies are not specific or predictive for HAVB and can be omitted.
Abstract

Keywords:
Conduction disturbancesTranscatheter valve replacement

More Related Videos

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement09:57

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

Published on: January 20, 2022

2.7K
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

3.8K

Related Concept Videos

Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
24
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
41
Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
38
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
32