Permanent Electrocardiostimulation in Patients after TAVR in the "Federal Center for Cardiovascular Surgery" (Krasnoyarsk)

Objective: to study the dynamics of the course of rhythm disturbances and conduction in patients after TAVR in severe aortic stenoses to reduce the frequency of implantation of pacemakers.

Materials and Methods: TAVR in patients with high surgical risk who were denied cardiac surgery. The analysis included 87 patients discharged from the hospital. The valves were CoreValve (84%), CoreValve Evolut R, Lotus, Edwards Sapien XT.

The first group included patients (n = 60), who had no negative dynamics of AV conduction in the postoperative period. The second group: newly emerged, or progressed AV blockade after TAVR (n = 27).

The technical success of the intervention, the occurrence of rhythm and conduction abnormalities after TAVR, the timing of development and resolution of rhythm and conduction disorders, the number of pacemaker implantations during hospitalization were assessed.

Results: According to various indicators, such as sex, age, history, the accompanying pathology of the group did not differ. Initially, the following conduction abnormalities were recorded in patients: left bundle branch blockade 8 (9.09%), blockade of the right bundle branch leg 8 (9.09%), AV blockade I-II st. 8 (9.09%). The basic statistics also did not reveal differences in anatomy, cardiac function, and technical performance of interventions.

Correlation analysis of Spearman revealed the connection between the occurrence of AV blockade with the initial size of opening of the native aortic valve (0.213165) and with the combined parameters of rhythm disturbance in the anamnesis (0.252602) (Table).It is noteworthy that most of the blockades of a high degree were resolved by 7 days after their occurrence.

In the first day after the TAVR procedure, AV blockades of I, II, III st. only 15 (17.04%), of which AV blockade III st. 6 (6.81%). In total, the pacemaker implantation was performed in 6 patients (6.81%).

It is noteworthy that most of the blockades of a high degree were resolved by 7 days after their occurrence.

Conclusions: Part of the AV blockade that develops after the TAVR procedure is reversible. Justified expectant tactics. It is advisable to implant the pacemaker no earlier than 7 days after the development of AV blockade. The presence of rhythm disturbances in a patient in an anamnesis should be alarming in terms of the risk of developing AV blockades.