This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Piazza, N. Articles by Serruys, P. W. Search for Related Content PubMed Articles by Piazza, N. Articles by Serruys, P. W.

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

This article has been cited by other articles:

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097. [Full Text] [PDF]

				S. H. Rahimtoola The Year in Valvular Heart Disease J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1894 - 1908. [Full Text] [PDF]

				N. Piazza, P. de Jaegere, C. Schultz, A. E. Becker, P. W. Serruys, and R. H. Anderson Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve Circ Cardiovasc Intervent, August 1, 2008; 1(1): 74 - 81. [Abstract] [Full Text] [PDF]