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JACC Cardiovasc Interv. 2012 Dec;5(12):1257-63. doi: 10.1016/j.jcin.2012.08.011.

Impact of a new conduction defect after transcatheter aortic valve implantation on left ventricular function.

Author information

1
Medical Clinic I, University RWTH Aachen, Aachen, Germany. rhoffmann@ukaachen.de

Abstract

OBJECTIVES:

This study sought to evaluate the impact of new conduction defects after transcatheter aortic valve implantation (TAVI) on the evolution of left ventricular (LV) function during 1-year follow-up.

BACKGROUND:

New left bundle branch block (LBBB) or need for permanent pacing due to atrioventricular (AV) block are frequent after TAVI.

METHODS:

A total of 90 consecutive patients treated with TAVI and who had 12-month echocardiographic follow-up were included in the study. In 39 patients, a new conduction defect (new LBBB or need for permanent pacemaker activity.) persisted 1 month after TAVI. In 51 patients, no persistent new conduction defect was observed. Two-dimensional echocardiography using parasternal short-axis, apical 4-chamber, and apical 2-chamber views was performed before TAVI and at 1-year follow-up to determine LV volumes and ejection fraction based on Simpson's rule. Speckle-tracking echocardiography was applied using standard LV short-axis images to assess the effect of new conduction defects on time-to-peak radial strain of different LV segments as a parameter of LV dyssynchrony.

RESULTS:

New conduction defects resulted in marked heterogeneity in time-to-peak strain between the 6 analyzed short-axis segments. During 1-year follow-up after TAVI, there was a significant increase in left ventricular ejection fraction (LVEF) in patients without new LBBB (53 ± 11% pre TAVI to 59 ± 10% at follow-up; p < 0.001), whereas there was no change in LVEF in patients with a new conduction defect (52 ± 11% pre TAVI to 51 ± 12% at follow-up, p = 0.740). Change in LV end-systolic volume was also significantly different between patient groups (-1.0 ± 14.2 vs. -11.2 ± 15.7 ml, p = 0.042). New conduction defect and LVEF at baseline were independent predictors of reduced LVEF at 12-month follow-up after TAVI.

CONCLUSIONS:

LVEF improves after TAVI for treatment of severe aortic stenosis in patients without new conduction defects. In patients with a new conduction defect after TAVI, there is no improvement in LVEF at follow-up.

PMID:
23257374
DOI:
10.1016/j.jcin.2012.08.011
[Indexed for MEDLINE]
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