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Assessment of atrioventricular conduction in aortic valve disease
Insights
Atrioventricular conduction disturbances are common in symptomatic aortic valve disease, particularly aortic stenosis and regurgitation. His bundle electrocardiography revealed prolonged conduction intervals, indicating delays above or below the His bundle.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Aortic valve disease (AVD) can affect cardiac function.
- Atrioventricular (AV) conduction disturbances are a potential complication.
Purpose of the Study:
- To investigate the prevalence of AV conduction disturbances in patients with symptomatic AVD.
- To differentiate conduction patterns between aortic stenosis and aortic regurgitation.
Main Methods:
- His bundle electrocardiography was performed on 26 patients with symptomatic AVD during cardiac catheterization.
- Patients were compared to a control group without AVD.
Main Results:
- Patients with AVD showed significantly prolonged PR, AH, and HV intervals compared to controls.
- Aortic stenosis was associated with prolonged HV intervals (delay below His bundle).
- Chronic aortic regurgitation was linked to prolonged PR and AH intervals (delay above His bundle).
- Acute aortic regurgitation from endocarditis did not show conduction disturbances.
- Valvular calcification and co-existing conditions like ventricular dysfunction or coronary artery disease did not significantly alter AV conduction patterns.
Conclusions:
- Atrioventricular conduction disturbances are frequent in symptomatic aortic valve disease.
- The location of the conduction delay differs between aortic stenosis and regurgitation.
- His bundle electrocardiography is valuable for assessing conduction abnormalities in AVD.
Abstract:
To determine the frequency of atrioventricular conduction disturbances in aortic valve disease, 26 consecutive patients (age 54 +/- 2 years) with symptomatic aortic valve disease were studied by His bundle electrocardiography at the time of cardiac catheterisation and were compared with a group of patients who underwent cardiac catheterisation and were found to have coronary artery or mitral valve disease but no aortic valve disease. Patients with aortic valve disease had significantly longer PR, AH, and HV intervals than cardiac patients not having this abnormality. Patients with aortic stenosis had prolonged HV, 52 +/- 6 vs +/- 42 +/- 2 ms (P = 0.06), whereas patients with chronic aortic regurgitation had prolonged PR, 245 +/- 27 vs 163 +/- 5 ms (P less than 0.001), and prolonged AH, 178 +/- 30 vs 102 +/- ms (P less than 0.001). Patients with combined lesions had significant prolongation of PR, AH, and HV intervals. Three patients with acute aortic regurgitation caused by endocarditis had normal atrioventricular conduction. Though the presence of valvular calcification did not significantly alter the pattern of atrioventricular conduction in these patients, those with calcified aortic valves had longer HV (P less than 0.005) than the control group. In addition, ventricular dysfunction or coronary artery disease did not affect the pattern of atrioventricular conduction in these patients. Thus, atrioventricular conduction disturbances are common in symptomatic aortic valve disease. With aortic stenosis the site of delay occurs more frequently below the His deflection, whereas in aortic regurgitation it is more frequent above the His deflection.