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Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve

Nicolo Piazza, MD^_*, Yoshinobu Onuma, MD^_*, Emile Jesserun, MD^_*, Peter Paul Kint, RN, Anne-Marie Maugenest, RN^_*, Robert H. Anderson, MD, FRCPath, Peter P. Th de Jaegere, MD, PhD^_*, Patrick W. Serruys, MD, PhD^_*,_*

^_* Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Cardialysis BV, Rotterdam, the Netherlands
Department of Pediatric Cardiology, Institute of Child Health, London, United Kingdom.

^_* Reprint requests and correspondence: Dr. Patrick W. Serruys, Department of Interventional Cardiology, Erasmus Medical Center, Thoraxcenter, Ba583a, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).

Objectives: In this retrospective study, we examined the incidence of post-procedural conduction abnormalities and the need for pacing in patients undergoing percutaneous implantation of the aortic valve.

Background: Safety and feasibility studies have suggested anecdotally the occurrence of conduction abnormalities and requirements for pacing after percutaneous implantation of the aortic valve.

Methods: We examined the standard 12-lead electrocardiograms (ECGs) of 40 consecutive patients in whom a CoreValve Revalving System (CoreValve, Paris, France) was implanted between November 2005 and March 2008. We examined the 12-lead ECG before treatment, after treatment, and at 1-month follow-up. We documented the requirements for temporary or permanent pacemaking.

Results: The mean age of patients was 82 ± 7 years. Post-procedural mortality at 72 h was 0%. There was a significant increase in the frequency of left bundle branch block (LBBB) after percutaneous aortic valve replacement (15% before treatment vs. 55% after treatment, p = 0.001). Although the incidence of LBBB had decreased after follow-up of 1 month, it did not reach statistical significance, with the proportion decreasing from 55% to 48% (p = 0.63). The only 2 patients with pre-treatment right bundle branch block became dependent on temporary pacing immediately after valve implantation and subsequently needed permanent pacing. A temporary and permanent pacemaker was required in 20% and 18% of patients, respectively.

Conclusions: In this study, there was a significant increase in the frequency of LBBB after percutaneous insertion of the aortic valvar prosthesis. Patients with pre-existing right bundle branch block may be at risk for the development of complete heart block and subsequent need for pacing.

Abbreviations and Acronyms   AV = atrioventricular   ECG = electrocardiogram   LBBB = left bundle branch block