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Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring

Mathieu Coeman (UGent) , Peter Kayaert (UGent) , Tine Philipsen (UGent) , Simon Calle (UGent) , Peter Gheeraert (UGent) , Sofie Gevaert (UGent) , Jens Czapla (UGent) , Liesbeth Timmers (UGent) , Frederic Van Heuverswyn (UGent) and Jan De Pooter (UGent)
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Abstract
Background: Newonset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of newonset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR. Methods and results: This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12-lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 +/- 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. Widening of QRS duration was comparable among both BEV and SEV patients (6.7 +/- 21.5 versus 17.0 +/- 26.9ms, p= 0.061) and occurred immediately after TAVR. New-onset left bundle branch blockwas seen in 18.5% of BEV and 30.8% of SEV patients (p = 0.120) and occurred within 24 h after TAVR in both groups. Late PPMI (>24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p= 0.008). Conclusion: Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR. (c) 2020 Published by Elsevier Inc.
Keywords
Cardiology and Cardiovascular Medicine, Transcatheter aortic valve replacement (TAVR), Electrocardiogram (ECG), Conduction disturbances, Pacemaker, Left bundle branch block (LBBB), CONDUCTION DISTURBANCES, QRS DURATION, PREDICTORS, IMPLANTATION, GUIDELINES, ASSOCIATION, CARDIOLOGY, SOCIETY, ESC

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MLA
Coeman, Mathieu, et al. “Different Dynamics of New-Onset Electrocardiographic Changes after Balloon- and Self-Expandable Transcatheter Aortic Valve Replacement : Implications for Prolonged Heart Rhythm Monitoring.” JOURNAL OF ELECTROCARDIOLOGY, vol. 59, 2020, pp. 68–73, doi:10.1016/j.jelectrocard.2020.01.005.
APA
Coeman, M., Kayaert, P., Philipsen, T., Calle, S., Gheeraert, P., Gevaert, S., … De Pooter, J. (2020). Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring. JOURNAL OF ELECTROCARDIOLOGY, 59, 68–73. https://doi.org/10.1016/j.jelectrocard.2020.01.005
Chicago author-date
Coeman, Mathieu, Peter Kayaert, Tine Philipsen, Simon Calle, Peter Gheeraert, Sofie Gevaert, Jens Czapla, Liesbeth Timmers, Frederic Van Heuverswyn, and Jan De Pooter. 2020. “Different Dynamics of New-Onset Electrocardiographic Changes after Balloon- and Self-Expandable Transcatheter Aortic Valve Replacement : Implications for Prolonged Heart Rhythm Monitoring.” JOURNAL OF ELECTROCARDIOLOGY 59: 68–73. https://doi.org/10.1016/j.jelectrocard.2020.01.005.
Chicago author-date (all authors)
Coeman, Mathieu, Peter Kayaert, Tine Philipsen, Simon Calle, Peter Gheeraert, Sofie Gevaert, Jens Czapla, Liesbeth Timmers, Frederic Van Heuverswyn, and Jan De Pooter. 2020. “Different Dynamics of New-Onset Electrocardiographic Changes after Balloon- and Self-Expandable Transcatheter Aortic Valve Replacement : Implications for Prolonged Heart Rhythm Monitoring.” JOURNAL OF ELECTROCARDIOLOGY 59: 68–73. doi:10.1016/j.jelectrocard.2020.01.005.
Vancouver
1.
Coeman M, Kayaert P, Philipsen T, Calle S, Gheeraert P, Gevaert S, et al. Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring. JOURNAL OF ELECTROCARDIOLOGY. 2020;59:68–73.
IEEE
[1]
M. Coeman et al., “Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring,” JOURNAL OF ELECTROCARDIOLOGY, vol. 59, pp. 68–73, 2020.
@article{8664339,
  abstract     = {Background: Newonset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of newonset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR.

Methods and results: This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12-lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 +/- 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. Widening of QRS duration was comparable among both BEV and SEV patients (6.7 +/- 21.5 versus 17.0 +/- 26.9ms, p= 0.061) and occurred immediately after TAVR. New-onset left bundle branch blockwas seen in 18.5% of BEV and 30.8% of SEV patients (p = 0.120) and occurred within 24 h after TAVR in both groups. Late PPMI (>24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p= 0.008).

Conclusion: Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR. (c) 2020 Published by Elsevier Inc.},
  author       = {Coeman, Mathieu and Kayaert, Peter and Philipsen, Tine and Calle, Simon and Gheeraert, Peter and Gevaert, Sofie and Czapla, Jens and Timmers, Liesbeth and Van Heuverswyn, Frederic and De Pooter, Jan},
  issn         = {0022-0736},
  journal      = {JOURNAL OF ELECTROCARDIOLOGY},
  keywords     = {Cardiology and Cardiovascular Medicine,Transcatheter aortic valve replacement (TAVR),Electrocardiogram (ECG),Conduction disturbances,Pacemaker,Left bundle branch block (LBBB),CONDUCTION DISTURBANCES,QRS DURATION,PREDICTORS,IMPLANTATION,GUIDELINES,ASSOCIATION,CARDIOLOGY,SOCIETY,ESC},
  language     = {eng},
  pages        = {68--73},
  title        = {Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2020.01.005},
  volume       = {59},
  year         = {2020},
}

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