The study protocol was approved by the Siriraj Institutional Review Board (SIRB) of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. It is possible that there may be a single standardized decision pathway that is suitable for use in CD patients.Īccordingly, the aim of this study was to investigate clinical, electrocardiographic, preprocedural imaging, and procedural variables to identify independent factors that predict new-onset conduction disturbances post-TAVR. Moreover, the data are still scarce relative to the clinical outcomes of patients with CDs compared between those treated with and without PPI. Because of these variations among treatment-related factors, including discrepancies in the indication and timing of PPI, the care decision pathway has not yet been conclusively established in this clinical setting. Based on this mechanism hypothesis, several studies have investigated the predicted risk for permanent pacemaker implantation (PPI) in patients with CDs, but some of the reported predictors were inconsistent among studies. The mechanism of CDs may be direct mechanical insult by the THV to conduction tissue, which results in ischemia, edema, or hemorrhage. Despite the development of the transcatheter heart valve (THV) to decrease periprocedural complications, new-onset conduction disturbances post-TAVR (hereafter collectively referred to as CD/CDs) remain relatively common. Transcatheter aortic valve replacement (TAVR) is an emerging therapeutic procedure in patients with symptomatic severe aortic stenosis who have intermediate to high surgical risk or who are inoperable. Registered 17 August 2021-Retrospectively registered, 20210818002. The optimal ∆MSID cutoff value was < 0 mm. Importantly, we expanded the CD criteria to cover all spectrum of TAVR-related conduction injury to lower the threshold of this sole modifiable risk. ∆MSID < 0 was the strongest and only modifiable predictor. This study identified MS length ≤ 6.43 mm and ∆MSID < 0 mm as independent predictors of CDs. The optimal ∆MSID cutoff value for predicting conduction disturbances was less than 0 mm (area under the receiver operating characteristic curve : 0.896). The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. ![]() Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. ![]() ResultsĪ total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. ![]() Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. MethodsĬonsecutive patients who underwent TAVR during December 2009–March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University-Thailand’s largest national tertiary referral center-were enrolled. The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs). Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR).
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