Arrhythmia Occurrence After Balloon-Expandable and Self-Expanding Transcatheter Pulmonary Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Arrhythmias following transcatheter pulmonary valve replacement (TPVR) beyond the early postprocedural period are not well-defined.
• The relationship between arrhythmia incidence and pulmonary valve replacement type (balloon-expandable vs. self-expanding) requires further investigation.

Purpose of the Study:

• To assess the incidence, types, and timing of arrhythmias after balloon-expandable pulmonary valve replacement (BEPVR) and self-expanding pulmonary valve replacement (SEPVR).

Main Methods:

• Retrospective review of patients undergoing TPVR from 2012 to 2022 with rhythm monitoring beyond 14 days postprocedure.
• Primary outcome: composite of all-cause mortality and life-threatening arrhythmia.
• Secondary outcomes: nonsustained ventricular tachycardia (NSVT), atrial fibrillation, and other supraventricular tachycardias.

Main Results:

• Sixty-eight patients were followed for a median of 4.0 years post-TPVR.
• Life-threatening arrhythmias occurred in 19.1% of patients, primarily after BEPVR.
• NSVT was the most frequent non-life-threatening arrhythmia (47.1%), significantly more common after SEPVR (P=0.03), and persisted beyond the early postprocedural period without association to mortality.

Conclusions:

• Arrhythmias are common after TPVR beyond the early postimplantation period.
• No statistical difference in life-threatening arrhythmias or mortality between BEPVR and SEPVR.
• NSVT is the most observed arrhythmia after TPVR, occurring more frequently after SEPVR, independent of prior arrhythmia history. Further studies are needed to clarify the prognostic implications of NSVT.