Electrocardiographic Changes Associated with Transapical Transcatheter Aortic Valve Implantation
berhane worku1, James Horowitz2, polydoros Kampaktsis2, Iosif Gulkarov1, Arash Salemi2.
1weill cornell medical center, Brooklyn, NY, USA, 2weill cornell medical center, New York, NY, USA.
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is associated with several conduction abnormalities and need for pacemaker placement. The aim of this study was to describe all electrocardiographic (EKG) changes seen after TAVI, to compare such changes between transapical (TA) and transfemoral (TF) cohorts, and to assess their impact on postoperative outcomes.
METHODS: Between March 2009 and July 2014, 286 consecutive patients underwent TAVI at our institution. Perioperative data were collected prospectively. Preoperative and predischarge electrocardiograms were retrospectively reviewed by an independent cardiologist. RESULTS: More TA patients experienced EKG changes than TF patients at the time of discharge (78% vs 42%; p<.0001), with more intraventricular conduction abnormalities (29% vs 15%; p=.006), and a trend towards more frequent atrioventricular block and pacemaker placement (table 1). Troponin levels were greater in patients with new EKG changes 4.61ng/ml vs 2.12ng/ml; p=.0009). New intraventricular conduction abnormalities were associated with increased one year mortality in the TF subgroup (65% vs 84%; p=.028) only. Six TA patients demonstrated new EKG findings of myocardial infarction, and this was associated with greater thirty day mortality (67% vs 98%; p=.012), although none met the clinical criteria for myocardial infarction.
CONCLUSIONS: New EKG changes after TAVI, and conduction abnormalities in specific, were seen more frequently in TA patients. When seen in TF patients, they are associated with decreased survival. EKG findings of new myocardial infarction, seen only in TA patients, are also associated with decreased survival. Further studies are needed to determine the mechanism of these changes and their association with the TA approach.
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