Conduction disturbances common after new-generation self-expanding valve implantation

22 May 2022
In intermediate risk patients, the TAVR is found to have better outcomes
In intermediate risk patients, the TAVR is found to have better outcomes

Implantation with new-generation, self-expanding aortic valves appears to result in a significant spike in the rates of high-degree cardiac conduction disturbance (HDCD), such as an increase in PR and QRS intervals, reports a new study.

The study included 344 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, all of whom received new-generation self-expandable valves. Electrocardiography parameters were assessed at baseline, before discharge, and after TAVR.

Immediately post-TAVR, researchers detected a large increase in PR interval (169.9 to 188.04 ms) and QRS complex width (101.7 to 129.55 ms) as compared with baseline values. This was followed by a partial in-hospital recovery (PR to 179.4 ms, QRS to 123.06 ms).

The net result was that by hospital discharge, both PR interval and QRS complex width saw a slight but significant increase from baseline, with respective change values of 12.6 and 21.4 ms (p<0.001 for both).

Overall, the global incidence rate of new-onset persistent HDCD was 46.3 percent at hospital discharge, with 17.7 percent of patients needing permanent pacemaker implants.

Valve recapture (odds ratio [OR], 2.8, 95 percent confidence interval [CI], 1.1–7.2; p=0.033) and an implantation depth ≥6 mm (OR, 1.9, 95 percent CI, 1.1–3.3; p=0.015) were significant risk factors for HDCD at discharge. Meanwhile, implantation depth <3

mm appeared to be significantly protective (OR, 0.3, 95 percent CI, 0.1–0.7; p=0.014).

“New generation self-expanding valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD,” the researchers said.

“These results should be validated in a large-scale prospective study to corroborate their predictive capacity,” they added.

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