The effects of transcatheter aortic valve implantation on cardiac electrical properties

Autores da FMUP

• José Adelino Lobarinhas Barbosa

  Autor

• Hernâni Manuel Da Silva Lobo Maia Gonçalves

  Autor

• Acácio Agostinho Gonçalves Rodrigues

  Autor

• Ricardo Manuel Alves Monteiro Fontes De Carvalho

  Autor

Participantes de fora da FMUP

• Manuel, AM
• Almeida, J
• Guerreiro, C
• Dias, T
• Teixeira, P
• Ribeiro, J
• Dias, A
• Caeiro, D
• Fonseca, M
• Teixeira, M
• Oliveira, M
• Primo, J
• Gama, V
• Braga, P

Unidades de investigação

• Cirurgia e Fisiologia

• Medicina da Comunidade, Informação e Decisão em Saúde

• Patologia

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) is associated with cardiac electrical disturbances. However, beyond the risks of pacemaker implantation, few studies have performed a detailed assessment of the effects of TAVI on several cardiac electrical properties. Objectives: To assess the frequency and type of electrocardiographic disturbances following TAVI, according to the type of prostheses and to assess predictors of these disturbances. Methods: We performed a detailed retrospective analysis of all electrocardiograms in patients who underwent TAVI, before and after the procedure, at a tertiary center from August 2007 to October 2016. Patients with permanent pacemakers were excluded. Results: We included 182 patients (78 +/- 8 years; 56% female) and self-expanding prostheses (SEP) were implanted in 54%. Most patients (80%) were in sinus rhythm at baseline. After TAVI, 21% of patients developed new-onset atrial fibrillation and there was a significant increase in PR interval at discharge (186 +/- 41 ms vs. 176 +/- 32; p=0.003), which was not maintained after at sixmonth follow-up (181 +/- 35 ms, p=0.06). There was also a significant increase in QRS duration at discharge (129 +/- 28 ms vs. 114 +/- 25 at baseline p<0.0001), which persisted at six-months (122 +/- 28 ms, p<0.0001). New-onset left-bundle branch block (LBBB) was observed in 25% of patients. The depth of valve implantation was a predictor of new LBBB at discharge after multivariate analysis (OR 37.6, 95% CI 14.6-65.2, p=0.001). Conclusions: The main electrocardiographic disturbances post TAVI were PR prolongation, increased QRS and new-onset LBBB. These disturbances were more pronounced in patients undergoing SEP implantation and tended to improve at six-month follow-up. The depth of valve implantation was a predictor of conduction disturbances. (C) 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U.

Keywords

• Aortic stenosis; Transcatheter aortic valve implantation; Electrocardiographic disturbances