IJCS | Volume 32, Nº5, September/October 2019

496 Figure 1 - New conduction disorders after transcatheter aortic valve implantation. TAVI: transcatheter aortic valve implantation; dis.: disorder; LBBB: left bundle branch block; RBBB: right bundle branch block; LAHB: left anterior hemiblock; IV: intraventricular; AV: atrioventricular; AVB: atrioventricular block; pat.: patients. 52 patients undergoing TAVI with ECG available for analysis 12 patients did not develop new conduction disorders - (23%) All patients were discharged. None had pacemaker implanted. 1 DEATH during outpatient follow-up 40 patients developed new conduction disorders - (77%) 23 patients developed new AV conduction disorders (44.2%) 4 patients developed NEW mixed conduction disorders. All with first-degree AVB and LBBB (7.8%) 13 patients developed NEW interventricular conduction disorders (25%) First-degree AVB / 5 pat. (9.6%) Second- degree AVB / 1 pat. (1.9%) Complete AVB / 17 pat. (32.7%) 4 DEATHS LBBB 16 pat. (30.7%) RBBB zero patient LAHB 1 pat. (1.9%) 16 patients undergoing permanent PACEMAKER implantation before discharge 14 patients with new LBBB were discharged (10 LBBB and 4 LBBB + first-degree AVB) Cedenilla et al. Requirements for permanent pacemaker afterTAVI Int J Cardiovasc Sci. 2019;32(5):492-504 Original Article normal AV and interventricular conduction before TAVI and remained without any conduction disorders after the procedure. Two patients had LBBB before TAVI and remained with LBBB after the procedure. One patient had an LAHB prior to TAVI and persisted with LAHB after the procedure and one patient who had first-degree AVB with RBBB maintained these electrocardiographic abnormalities after implantation. Of the 53 patients included in the study, 16 (30.18%) had a permanent pacemaker implanted before discharge. The pacemaker was implanted in the operating room after TAVI in 11 of the 16 patients (68.7%). These 11 patients maintained complete atrioventricular block and escape rhythm with enlarged QRS complexes during pacemaker inhibition at the end of the procedure. In 5 patients, the pacemaker recommendation occurred between the 3rd and the 8th day after the procedure. CAVB was the recommendation of pacemaker implant in 5 of the 6 patients. In 1 patient, the pacemaker was recommended by second-degree AVB. Four of the 53 patients (7.5%) died before discharge. All deaths occurred in female patients. Three died of complications related to the procedure in the first 24 hours of implantation and one death occurred 48 days after TAVI due to cardiogenic shock. All patients who died had developed new conduction disorders (Figure 1). Predictors of the need for pacemaker Forty-nine patients were discharged. Table 4 compares the characteristics of the 16 patients who underwent pacemaker implantation with the characteristics of the 33 who were dischargedwithout the need for pacemaker implantation. In the univariate analysis, the percentage of patients with QRS complexes ≥ 120 ms and first-degree AVB was higher in the group that was discharged with permanent pacemaker than in those who did not need this device. QRS ≥ 120 ms was present in 68.8% of the patients who had pacemakers implanted and in 28.1% of those who did not have pacemakers implanted (odds ratio: 5.62; 95% CI 1.52 to 20.80; p = 0.012). First- degree AVB was found in 50% of the patients who had pacemakers implanted and in 7.1% of those who did not have it implanted. (Table 4)