0299 : Use of clinical follow-up and pacemaker memories to define predictors of complete atrio-ventricular block or sudden death after balloon- expandable transcatheter aortic valve implantation

BackgroundsPredictors of atrio-ventricular block (AVB) after transcatheter aortic valve implantation (TAVI) have been described as those leading to syncope or permanent pacemaker implantation (PPI), and thus have been assimilated to criterias used by the investigators for pacemaker implantation.AimsEvaluating the true predictors of AVB following TAVI, using clinical follow-up and devices’ memories.MethodsBetween 2011 and 2013, 213 patients without previous PPI underwent TAVI with an Edwards SAPIEN XT balloon-expandable valve using a femoral approach, in our institution. All patients had continuous cardiac rhythm monitoring ≥24 hours after TAVI. ECG was performed the following 2 days after TAVI, and 1 month later. Median follow-up for pacemaker interrogation was 8 months.ResultsComplete AVB occurred in 22 patients (10.3%), sudden death in 8 patients (3.8%). Pacemaker was implanted in 26 patients (12.2%). For 20 of them (77%), pacemaker memories showed complete AVB episodes or ≥2% ventricular pacing, despite the use of a minimizing ventricular pacing algorithm. Results of the multivariate analysis are shown below. TableNo complete AVB or Sudden death (%)Complete AVB or Sudden death (%)Odds Ratio (95% CI)PPreexisting RBBB15 (8)13 (43)6.62 (1.7 - 26.3)0.007New persistant LBBB14 (8)8 (33)10.1 (2.5 – 41.7)0.0011st degree AVB after TAVI34 (27)9 (56)3.48 (1.1 – 11.2)0.04LBBB: left bundle branch block; RBBB: right bundle branch blockConclusionsOur findings confirmed pre-existing RBBB and new persistent LBBB as predictors of AVB following TAVI. We also demonstrated here for the first time, first degree AVB is an independent predictive factor of severe conduction disorders after TAVI