Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR.

BACKGROUND

Left ventricular conduction disturbances (VCD) with or without need for pacemaker (PM) implantation are common after transcatheter aortic valve replacement (TAVR). Its effect on patients' functional recovery after TAVR is unclear.

METHODS AND RESULTS

212 patients (Age 80.8 ± 6.4 years, logEuroscore 28.95 ± 17.37 %) underwent TAVR with the self-expanding CoreValve prosthesis and completed 9-month follow-up (FU). After TAVR 125 (59 %) patients were diagnosed with VCD. This group consists of 41 (19 %) patients with a new PM after TAVR, 33 (16 %) patients with PM prior TAVR and markedly increased ventricular stimulation rate, 48 (23 %) patients with new LBBB post-TAVR and three (1 %) patients with LBBB prior TAVR. After FU, the presence of VCD alone was associated with worse recovery of left ventricular ejection fraction (LVEF) (VCD: LVEFbaseline 51.7 ± 18.2 %, LVEFFU 53.9 ± 13.0 %; p = 0.8; noVCD: LVEFbaseline 53.8 ± 12.9 %, LVEFFU 63.4 ± 10.1 %; p < 0.01) but had no impact on functional outcomes after TAVR (p > 0.05). Especially patients with VCD caused by permanent RV pacing showed worse functional outcomes presenting with higher functional NYHA classes (p < 0.05), and higher NT-proBNP levels (p < 0.05). 20.4 % of patients with need for PM after TAVR remained in NYHA class ≥3, as compared to 5 % of patients without PM (VCD but no PM: 4.7 %, p < 0.001; noVCD: 5.3 %, p < 0.001). VCD with or without need for PM had no impact on survival after FU.

CONCLUSION

The occurrence of VCD after TAVR is common and associated with unfavorable left ventricular functional recovery. However, only the combination of VCD with permanent right ventricular pacing has adverse impact on heart failure-related symptoms after TAVR.