May 4, 2011Circulation Cardiovascular Interventions
Atrioventricular Conduction Disturbance Characterization in Transcatheter Aortic Valve Implantation With the CoreValve Prosthesis
Key result
CoreValve transcatheter aortic valve implantation significantly prolonged QRS, PR, AH, and HV intervals, causing persistent conduction disturbances in 78% of patients.
Why the study?
Does CoreValve transcatheter aortic valve implantation affect atrioventricular conduction in pacemaker-free patients?
Population
18 consecutive, permanent pacemaker-free patients undergoing CoreValve transcatheter aortic valve implantation
Comparison
CoreValve transcatheter aortic valve… vs Baseline
Design
Cohort
Follow-up
Immediately after procedure
Authors
Discussion
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Implication
CoreValve TAVI warrants close post-procedural conduction monitoring; leaves open questions on long-term pacing needs and valve-specific risks.
Key Points
- To characterize the acute effects and electrophysiological mechanisms of CoreValve transcatheter aortic valve implantation on atrioventricular conduction.
- Conducted an electrophysiological study before and after CoreValve implantation in 18 consecutive patients without baseline permanent pacemakers.
- Positioned an intracardiac electrode on the His bundle to continuously record electrograms alongside surface ECG throughout the valve deployment procedure.
- Surface ECG revealed significant median increases in QRS width (96 to 150 ms, P=0.001) and PR interval (180 to 210 ms, P=0.008), alongside leftward QRS axis deviation (30° to -20°, P=0.005).
- Intracardiac recordings showed significant prolongations in both the AH interval (97 to 115 ms, P=0.021) and the HV interval (52 to 60 ms, P=0.002).
- Persistent conduction disturbances occurred in 14 of 18 (78%) patients by the end of the procedure, while 5 patients developed transient conduction abnormalities including AV block and left bundle branch block.
Study Design
Type
Observational (n=18)
Structured PICO
Does CoreValve transcatheter aortic valve implantation affect atrioventricular conduction in pacemaker-free patients?
P
Population
18 consecutive, permanent pacemaker-free patients undergoing CoreValve transcatheter aortic valve implantation, evaluated immediately before and after the procedure.
E
Exposure
CoreValve transcatheter aortic valve implantation (TAVI) with continuous electrophysiological monitoring
C
Comparator
Baseline (immediately before CoreValve implantation)
O
Outcome
Changes in atrioventricular conduction parameters (QRS width, PR interval, QRS axis, AH interval, HV interval) immediately before and after implantationsurrogate
CoreValve TAVI frequently causes direct damage to the His bundle or AV node, leading to transient or permanent AV conduction worsening in the majority of patients.
Cite This Study
Rubín et al. (2011) conducted an observational in Atrioventricular conduction disturbance in TAVI (n=18). CoreValve transcatheter aortic valve implantation vs. Pre-implantation baseline was evaluated on ECG- or electrophysiological study-persistent conduction disturbances. CoreValve transcatheter aortic valve implantation significantly prolonged QRS, PR, AH, and HV intervals, causing persistent conduction disturbances in 78% of patients.