Conduction Disorders After Transcatheter Aortic Valve Implantation: Evolution Over Time and Association With...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transcatheter aortic valve implantation (TAVI) indications are expanding.
• New conduction abnormalities (CA), such as left bundle branch block (LBBB) or permanent pacemaker (PPM) implantation, are significant TAVI complications.
• Limited data exist on the long-term outcomes of post-TAVI CA.

Purpose of the Study:

• To investigate the progression of CA within the first year post-TAVI.
• To evaluate the long-term prognostic value of these CA.
• To assess the impact of CA on left ventricular function and all-cause mortality.

Main Methods:

• Categorized TAVI patients into: PPM implantation within 1 year, persistent LBBB at 1 year (permanent LBBB), or no CA.
• Assessed all-cause mortality as the primary endpoint.
• Collected data on baseline characteristics, valve type, left ventricular ejection fraction, global longitudinal strain, and long-term survival.

Main Results:

• 30% developed new LBBB, 17% had persistent LBBB, and 12% required PPM during hospitalization.
• At 1 year, PPM and permanent LBBB groups showed reduced left ventricular ejection fraction and global longitudinal strain compared to the no-CA group.
• Long-term follow-up (median 4 years) revealed higher all-cause mortality in the PPM group (p=0.006).

Conclusions:

• Post-TAVI CA exhibit dynamic changes within the first year.
• Patients requiring PPM after TAVI demonstrate poorer long-term outcomes and impaired left ventricular function.
• PPM implantation and reduced global longitudinal strain are independent predictors of mortality post-TAVI.