Heart Rhythm Conduction Disturbances in Patients Who Underwent Transcatheter Aortic Valve Implantation – TAVI

Very few data exist on the clinical impact of Transcatheter Aortic Valve Implantation (TAVI) on heart rhythm conduction disturbances and early predictors for Pacemaker (PM), Implantable Cardioverter Defibrillator (ICD) or Cardioverter Defibrillator resynchronization (CRT-D). The aim of this study was to investigate whether the patients after TAVI (in POLTAVI registry) have heart rhythm conductions disturbances and what are the predictors for pacemaker implantation during in-hospital stay. We analyzed 330 patients from POLTAVI registry with severe symptomatic aortic stenosis and high risk for surgery. RBBB (n=11 [18.6%] vs. n=7 [58.3%]; P=0.004) and larger aortic annulus diameter (P=0.007) were significantly more frequent in patients who required PM or ICD or CRT-D implantation after TAVI. Continuous RV pacing during procedure was significantly more frequent in patients who needed PM implantation after TAVI (P=0.0001). Patients who needed pacing device implantation after TAVI had significantly wider QRS (>120 ms) and markedly more often bifascicular block with or without atrio-ventricular I° block (P=0.002). Pacemaker implantation after TAVI was necessary in 19.2% of patients with CoreValve and 8.3% with Edwards Sapien valve. The independent risk factor for pacing after TAVI in logistic regression analysis was CoreValve implantation (HR 3.93 95% CI 1.78 8.65; P=0.0007). The independent risk factor for PM implantation is usage of CoreValve. RBBB before the TAVI procedure bifascicular block with or without atrio-ventricular I° block after TAVI, continuous pacing during the TAVI procedure and larger aortic valve diameter were the main factors associated with long-term pacing.