Valvular heart disease
Frequency of Conduction Disturbances After Transcatheter Implantation of an Edwards Sapien Aortic Valve Prosthesis

https://doi.org/10.1016/j.amjcard.2010.04.029Get rights and content

We evaluated the incidence of conduction abnormalities and requirement for permanent pacemaker in patients undergoing transcatheter aortic valve implantation (TAVI) with the Edwards Sapien prosthesis. In 2009, >8,000 patients were treated with TAVI using 1 of the 2 commercialized models of bioprosthesis (Edwards Sapien, Edwards Lifesciences, Irvine, California; and CoreValve, Medtronic, Irvine, California). Occurrence of conduction abnormalities including complete atrioventricular block requiring permanent pacemaker has been reported after TAVI with the 2 models of valve, more frequently with the CoreValve. We analyzed standard 12-lead electrocardiograms of 69 consecutive patients in whom an Edwards Sapien prosthesis was successfully implanted. Electrocardiograms were examined before treatment, at day 1, and at 1-month follow-up. Heart rate, PR and QT intervals and QRS duration were measured and the presence of a first-, second-, or third-degree atrioventricular block was documented. There was a slight increase in heart rate and a discrete decrease in QT interval at day 1. These values had returned to baseline values at 1 month. There was no change in PR interval but a transitory increase in QRS duration was noted. Frequency of left bundle branch block increased from 14.5% at baseline to 27.5% at day 1 with a decreased incidence at day 30 (21.3%). Permanent pacemaker was required in only 3 patients (4.3%). In conclusion, in our experience, conductive disorders and requirement of a definitive pacemaker after implantation of an Edwards Sapien aortic bioprosthesis are infrequent. The physical properties of this prosthesis may explain this observation.

Section snippets

Methods

From April 2006 to May 2009, 87 consecutive patients with severe aortic stenosis underwent implantation with an Edwards Sapien prosthesis at Rouen University Hospital (Rouen, France). They were included in 2 prospective European multicenter feasibility studies (Registry of EndoVascular Implantation of Valves in Europe [REVIVE] and Placement of AoRTic TraNscatheter valves trial (EUrope) [PARTNER-EU]) and thereafter in the European SOURCE postmarket registry. Inclusion criteria were an aortic

Results

TAVI was performed using the transfemoral approach in 54 patients (78.2%) and the transapical approach in 15 patients (21.8%). Mean hospital stay was 10.1 ± 6.5 days. Electrocardiograms were analyzed in all 69 patients at day 1 and in 64 of 69 patients at 1 month; 3 patients died within the interval and 2 ECG tracings were not available for interpretation. Clinical evaluation was obtained during follow-up in all cases. Survival at 1 month was 95.6%.

Before the procedure, most patients (79.7%)

Discussion

New-onset AV block is a classic complication of surgical aortic valve replacement, requiring the implantation of a pacemaker in approximately 6% of interventions.17, 18 This is mainly caused by surgical trauma to the very near conduction system,7, 19 which emerges in the ventricles on the crest of the ventricular septum. The left bundle branch exits 2 to 3 mm below the base of the triangle formed by the noncoronary and right coronary cusps of the aortic valve, close to the annulus and left

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  • Cited by (70)

    • Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis

      2015, American Journal of Cardiology
      Citation Excerpt :

      Furthermore, delayed (i.e., >24 hours after the procedure) high-grade atrioventricular block has never been reported using the Edwards SAPIEN-XT prosthesis. In contrast, with the Corevalve, the incidence of complete atrioventricular block requiring permanent pacemaker is higher, occurring in up to 25% of cases and can be delayed, thus requiring prolonged electrocardiographic monitoring after TAVI.15–17 By multivariable analysis, the most powerful predictive factor of early discharge failure was transfusions.

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    Dr. Cribier is a consultant for Edwards Lifesciences (Irvine, California).

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