Background: Up to 25% of patients undergoing transcatheter aortic valve implantation (TAVI) will require an implantable permanent pacemaker within 7 days of the procedure. The development of bundle branch block after TAVI has been associated with higher rates of complete atrio-ventricular block (AVB), syncope, and sudden cardiac arrest. The occurrence of AVB is partly related to the direct mechanical stress of the prosthesis over the adjacent bundle branch. Yet, there are pathologic reports which demonstrate a local inflammation, fibrosis and tissue in-growth in the proximity of the prosthesis, regardless of prosthesis type. Accordingly, we assessed the impact of pre-procedural steroid treatment on the occurrence of conduction defects after TAVI procedure and evaluated the safety of this treatment.
Methods and results: A cohort of 324 patients who underwent trans-femoral TAVI was divided into 2 groups: patients treated with steroids pre-procedurally (n=39, 12%) and patients not treated with steroids (n=285, 88%). Thirty-day mortality and complication rates were examined using Cox logistic regression estimates and proportional hazards models. The decision for steroid treatment was made by the treating physician and based upon prior Iodine allergy (n=29) or active obstructive pulmonary disease (n=10). Both groups had similar baseline characteristics. Parameters found to be statistically significant for the development of new conduction defects were CoreValve prosthesis, low implantation and smaller aortic annulus diameter
(p<0.001, p<0.001 and p=0.006 respectively). Steroid pre-treatment failed to reduce the occurrence of new conduction defects in the entire group and also among CoreValve implanted patients specifically. Thirty day mortality and complication rates including sepsis, length of hospital stay and vascular complications showed no statistically significant differences between the 2 groups.
Conclusion: Steroid treatment prior to TAVI procedure was found to be safe. No benefit was demonstrated regarding the incidence of new conduction defects among these patients.
