Transcatheter aortic valve implantation (TAVI) can potentially alter conduction system
function due to the mechanical force applied to the conduction system by the proximal
edge of the valve, particularly the CoreValve. Some reasons for post-TAVI advanced
atrioventricular block have been identified. We investigated whether the degree of
the motion of the basal left ventricular (LV) walls impacted the development of advanced
atrioventricular block post-TAVI. A total of 407 patients (82.1 ± 6.2 years) without
prior permanent pacemakers (PPMs) underwent TAVI using CoreValve (70%) or Edwards-SAPIEN
(30%) prosthetic devices. The LV fractional shortening (FS) of the basal segments
was measured in each patient, and the association between FS and PPM requirement,
or new-onset left bundle branch block (LBBB) was evaluated. During hospitalization,
64 patients (15.7%) required PPM implantation, and 128 patients (31.4%) required PPM
implantation or developed new LBBB. Independent predictors of PPM implantation included
preprocedural right bundle branch block, CoreValve prosthetic device, valve implantation
depth, and FS. Patients with high FS (≥40%, upper tertile) had a 2.5-fold increased
risk of PPM implantation (p = 0.004) and a 1.8-fold increased risk of PPM or new LBBB
(p = 0.020). Every 10% increment in FS was consistently associated with an adjusted
42% increased risk of PPM implantation (p = 0.015) and with an adjusted 43% increased
risk of PPM implantation or new LBBB (p = 0.005). Thus, in our cohort, LV FS was independently
associated with the need for PPM implantation during hospitalization. Hence, this
simple echocardiographic measure can be used to identify patients who are at risk
after TAVI.
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Article Info
Publication History
Published online: June 02, 2018
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