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Published on: June 3, 2018
Impact of implantation depth and calcium burden on infranodal conduction delay after transcatheter aortic valve
Andrea Papa1, Teodor Serban1, Ivo Strebel1
1Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
Calcium in the non-coronary sinus (LVOTNCC) predicts conduction delays after transcatheter aortic valve replacement (TAVR). Implantation depth does not predict these common post-TAVR complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Infranodal conduction disorders frequently occur after transcatheter aortic valve replacement (TAVR).
- The precise risk factors contributing to these conduction abnormalities remain incompletely understood.
Purpose of the Study:
- To investigate the influence of valve implantation depth and the calcium burden in the device landing zone on infranodal conduction.
- To assess pre- and post-TAVR His-ventricle (HV) intervals to understand conduction changes.
Main Methods:
- Measured His-ventricle (HV) interval pre- and post-TAVR in 101 patients.
- Defined infranodal conduction delay as HV interval >55 ms.
- Quantified valve implantation depth and calcium volume in specific aortic regions, including the left ventricular outflow tract (LVOTNCC).
Main Results:
- 37% of patients experienced infranodal conduction delay post-TAVR.
- No correlation was found between implantation depth or overall calcium burden and the change in HV interval (delta HV).
- Calcification in the LVOTNCC region was a significant predictor of infranodal conduction delay (OR 1.62 per 100 mm³ increase, P = .04).
Conclusions:
- LVOTNCC calcification is a key predictor of infranodal conduction delay following TAVR.
- Valve implantation depth does not appear to influence the risk of developing conduction delays.
Background:
Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.
Objective:
The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.
Methods:
In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOTNCC, LVOTRCC, LVOTLCC, respectively).
Results:
Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm3 [interquartile range 632-2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = -0.08 and r = 0.12, respectively). However, LVOTNCC calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm3 increase (95% confidence interval 1.06-2.69; P = .04).
Conclusion:
Assessment of LVOTNCC calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.
