Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with edwards sapien prosthesis

Abstract

Porpse: Permanent pacemaker requirement is a known complication after transcatheter aortic valve implantation (TAVI). The aim of the present study was to analyze the effects of Edwards Sapien prosthesis implantation on atrioventricular conduction. Methods: The study included 28 patients who underwent TAVI due to severe aortic valve stenosis. An electrophysiological study was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after Edwards Sapien prosthesis implantation. Results: HV interval was significantly prolonged after the procedure (55.9±11.5 ms) in comparison to before the procedure (47.3±7.8) (p<0.001). The antegrade Wenckebach point was observed as being significantly prolonged after the procedure (354.4±41.3) rather than before (333.7±45.4) (p=0.001). Despite AH interval prolongation, it was not statistically significant. After the procedure, we observed significant conduction disturbances in three (10.7%) patients. These conduction problems recovered before discharge. One of the patients (3.6%) with RBBB+LAFB required permanent pacemaker implantation. At electrocardiogram after procedure QRS duration increased, QRS axis shifted to the left and both of the values became normal before discharge. The patients' echocardiographic and clinical parameters were improved during follow-up. Conclusions: The effect of Edwards Sapien on the conduction system was mostly infranodal and temporary. The physical properties of the Edwards Sapien prosthesis may explain this observation. This complication may be lessened if the frame height characteristics can be improved.