Original title: Impact of a New Conduction Defect Alter Transcatheter Aortic Valve Implantation on Left Ventricular Function Reference: Rainer Hoffmann, et al. J Am Coll Cardiol Intv 2012;5:1257– 63.

TAVI development in high risk patients can produce new conduction defects and require a definitive pacemaker in almost a third of treated patients. 

The aim of this study was to evaluate the impact of new conduction defects after TAVI on left ventricular function at 1 year follow up. The prospective analysis included 90 consecutive patients between January 2009 and July 2010.

Implanted valves were Corevalve in 52 patients and Edwards SAPIENS in 38. LV volumes and ejection fraction were similar in both groups prior to procedure. New conduction defects presented in 39 patients, 31 of these patients presented left bundle branch block (12 finally requiring permanent pacing) and 8 patients presented complete AV block and definite pacemaker implantation. New conduction defects presented in 32 of the Core Valve implanted patients and 7 of those who received the Edwards SAPIENS valve.

Patients who did not present new conduction defects showed significant improvement of LVEF compared to baseline (5.8 ± 7.9%; p= 0.001) and end -systolic volume. In the group of patients that presented new conduction defects the LVEF practically did not show changes at 12 months. There was no difference in LVEF associated to the implanted valve. The presence of new conduction defects and baseline LVEF were predictors of reduced LVEF at 12 months.

Conclusion 

Ejection fraction after TAVI improves in those patients that do not present new conduction defects, this does not happen in patients that do present new conduction defects.

Editorial Comment:

Despite de fact that new conduction defects and permanent pacing requirements after TAVI are frequent, this does not necessarily translate into greater mortality, despite the ventricular function may see no improvement. Although surgery has brought less conduction defects, it has been performed in less complex patients compared to the ones treated with this technique; this may be contributing to new conduction defects. As regards valves, they will eventually require improvement in order to reduce such complications. 

Courtesy of Dr Carlos Fava,
Interventional Cardiologist,
Favaloro Foundation, Argentina.

Dr. Carlos Fava para SOLACI.ORG