IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190020 492 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(5):492-504 Mailing Address: Marcela Cedenilla dos Santos Av. Epitácio Pessoa, 2990/708. Postal Code: 22471-003, Lagoa, Rio de Janeiro, RJ - Brazil. E-mail: marcelasantos@cardiol.br, lacerda@cardiol.br Incidence of Conduction Disorders and Requirements for Permanent Pacemaker After Transcatheter Aortic Valve Implantation Marcela Cedenilla dos Santo s, C ristiane da Cruz Lama s, F abiula Schwartz de Azeved o, A lexandre Siciliano Colafrancesch i, C lara Weksle r, L eandro Cordeiro Dias Rodrigue s, G ustavo de Castro Lacerd a Instituto Nacional de Cardiologia (INC - MS), Rio de Janeiro, RJ - Brazil Manuscript received December 23, 2017; revised manuscript September 12, 2018; accepted November 01, 2018. Abstract Background: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non- operable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3 rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve ® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM. (Int J Cardiovasc Sci. 2019;32(5):492-504) Keywords: Atrioventricular Block; Bundle-Branch Block; Aortic Valve Stenosis/therapy; Transcatheter Aortic Valve Implantation/methods. Introduction Aortic stenosis (AoS) is the most common valve disease in developed countries, affecting approximately 3% of the population older than 75. 1 In Brazil, with an increase in life expectancy, a significant increase in cases of degenerative AoS is expected for the coming years. 2 The mortality rate of patients with symptomatic AoS is approximately 50% in the first 2 years with no surgical treatment. 3,4 Aortic valve replacement is associated with low mortality when performed in patients without severe comorbidities. 5 However, at least 30% of symptomatic patients with severe AoS are not operated because of the presence of comorbidities, ventricular dysfunction or old age. 6,7 A less invasive form of treatment would be an attractive alternative for patients with high surgical risk. Transcatheter aortic valve implantation (TAVI) is a recently developed technique for the treatment of symptomatic patients with severe AoS considered to be inoperable or at high surgical risk. 8-13 The 2 types of aortic valve prosthesis most used for percutaneous