Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis

Highlights

• Conduction disturbances after TAVR are common with SEV. However electrocardiographic changes with new generation SEV have not been described.

• New generation SEV is associated with significant PR interval prolongation and QRS widening immediately post-TAVR and at discharge.

• While implantation depth and valve recapture were independent predictors of HDCD at discharge, Acurate-neo valve was associated with lower rates of HDCD.

• Baseline RBBB, valve recapture, low implantation depth and significant increase in PR interval and QRS widening post-TAVR, predicted a higher in-hospital PPM rate with a modest discriminatory ability.

Abstract

Background

High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR.

Methods and results

Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p < 0.001), respectively. The global incidence of new onset persistent HDCD at hospital discharge was 46.3%, with 17.7% of patients requiring PPM. Independent predictors of new onset HCDC at hospital discharge were valve recapture (OR: 2.8; 95% IC: 1.1–7.2, p = 0.033) and implantation depth ≥ 6 mm (OR: 1.9 05% IC 1.1–3.3, p = 0.015), while higher implantation (<3 mm (OR: 0.3, 95% IC 0.1–0.7, p = 0.014) and use of Acurate-Neo valve (OR: 0.4; 95% IC 0.2–0.8, p = 0.009) were protective factor.

Conclusions

New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.