Op 15/10 vindt er onderhoud plaats aan de Radboud Repository. Het is mogelijk dat uw zoekactie incomplete resultaten oplevert. Indien u publicaties wilt uploaden kunt u dit doen via de Upload Full Text button. *** On October 15th, the Radboud Repository will be undergoing maintenance. Please note that your search may produce incomplete results. If you would like to upload publications, you can do so by means of the Upload Full Text button
Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation.
until further notice
SourceCatheterization and Cardiovascular Interventions, 85, 5, (2015), pp. 144-152
1 april 2015
Article / Letter to editor
Display more detailsDisplay less details
Cardio Thoracic Surgery
Catheterization and Cardiovascular Interventions
SubjectRadboudumc 0: Other Research RIMLS: Radboud Institute for Molecular Life Sciences
OBJECTIVES: The aim of the study was to investigate trends over time in the occurrence of left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve System (MCS) and Edwards SAPIEN Valve (ESV). BACKGROUND: TAVI-induced conduction abnormalities (TAVI-CAs) such as LBBB and the need for PPI are frequent postoperative complication. New techniques, procedural refinements, and increased awareness are focused on the reduction of these abnormalities. METHODS: Electrocardiograms of 549 patients without preprocedural LBBB and/or pacemaker were assessed to determine the frequency and nature of TAVI-CAs. To study the effect of experience, patients were subdivided per center into tertiles based on the number of procedures. Univariate and multivariate logistic regression was used to study predictors of TAVI-induced LBBB (TAVI-LBBB) and PPI. RESULTS: TAVI-LBBB occurred in 185 patients (33.7%) and significantly decreased over time, from 42.6% to 27.3% (P = 0.006). This effect was only significant after implantation of the MCS (59.6% vs. 46.5% vs. 31.1%, P = 0.001, ESV: 22.6% vs. 13.1% vs. 24.8%, P = 0.11). Between tertiles there was no difference in the frequency of PPI after TAVI (n = 73, 13.1% vs. 14.8% vs. 12%, P = 0.74). Multivariate analysis revealed that, independent from valve type, depth of implantation was the only significant predictor of TAVI-LBBB (OR [95% C.I.]: 1.16 [1.10-1.24], P < 0.001). In case of PPI pre-existing RBBB (OR [95% C.I.]: 7.22 [3.28-15.88], P < 0.001) was the only significant predictor. CONCLUSIONS: Over time the frequency of LBBB after TAVI decreased significantly, especially in patients undergoing TAVI with the MCS. Experience and the subsequent reduction in depth of implantation seem responsible for this reduction. Contrary to TAVI-LBBB, the incidence of PPI remained unchanged over time and was not affected by experience. Although experience has led to a decrease in new CAs after TAVI, elucidation of pathophysiologic mechanisms underlying these CAs and subsequent changes in patient stratification, valve design and the procedure are needed to further reduce this complication. (c) 2014 Wiley Periodicals, Inc.
Upload full text
Use your RU credentials (u/z-number and password) to log in with SURFconext to upload a file for processing by the repository team.