Incidence of atrioventricular conduction disturbances and need for pacemaker implantation in patients after endovascular aortic valve replacement

The aim of the study was to evaluate predictors of cardiac conduction disturbance associated with increased risk of temporary and permanent pacemaker implantation after endovascular aortic valve replacement (TAVR). Material and methods. We analyzed patients who underwent surgical treatment for aortic valve replacement by endovascular treatment in Krasnoyarsk Regional Clinical Hospital from January 2018 to May 2023. The total number of people included in the study is 157. Results and discussion. The association between the occurrence of atrioventricular block of II–III degree, left bundle branch block and atrial fibrillation after TAVR implantation, which required temporary pacemaker implantation and permanent pacemaker implantation, was revealed. Atrioventricular block of grade II-III was first detected in 11 (13.3 %) patients after TAVR, left bundle branch block – in 22 (26.5 %) and atrial fibrillation – in 11 (13.3 %). The need for temporary pacing during TAVR was necessary in 35 (23.6 %) patients. 34 (23.0 %) patients had a temporary pacemaker placed within the first 2 days after surgical intervention and 1 patient (0.7 %) after 3 days. Regression analysis revealed 6 significant risk factors for temporary pacemaker implantation: left bundle branch block (p = 0.002), atrial fibrillation (p = 0.030), 1st degree atrioventricular block (p = 0.032), age (p = 0.012), female gender (p = 0.033) and history of acute myocardial infarction (p = 0.024). Permanent pacemaker implantation was performed in 7 (4.5 %) patients in the period from 4 to 20 days, including 6 (85.7 %) patients due to complete atrioventricular block and 1 (14.3 %) patient due to sinus node dysfunction. Permanent pacemaker was implanted to five (3.2 %) patients in the period from 6 months to 3.6 years, including 3 (1.9 %) patients due to complete atrioventricular block and 2 (1.3 %) patients due to sinus node dysfunction. Regression analysis revealed 2 significant risk factors for permanent pacemaker implantation: presence of atrial fibrillation before surgical intervention (p = 0.002; r = 0.160) and presence of left bundle branch block before TAVR (p = 0.037; r = 0.108). Conclusions. Identification of predictors of atrioventricular block of II–III degrees after TAVR will facilitate timely temporary pacing and permanent pacemaker implantation to prevent complications due to bradyarrhythmias.

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