Steroid therapy and conduction disturbances after transcatheter aortic valve implantation

Ofer Havakuk, Maayan Konigstein, Eyal Ben Assa, Yaron Arbel, Yigal Abramowitz, Amir Halkin, Samuel Bazan, Haim Shmilovich, Gad Keren, Ariel Finkelstein, Shmuel Banai

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI. Methods and results: From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10). We compared the rate of occurrence of new conduction disturbances and pacemaker implantation between TAVI patients with (n=39) and without (n=285) steroid treatment, using Cox logistic regression estimates and proportional hazards models. The overall occurrence of new conduction defects and the need for new pacemaker implantation were similar among steroid and non-steroid-treated patients (38.4% vs 37.5% and 25.6% vs 25.3%, respectively). New conduction disturbances were more prevalent in patients treated with CoreValve prosthesis, low implantation, and smaller aortic annulus diameter (P<.001, P<.001, and P=.006, respectively). Thirty-day mortality and complication rates were similar between the groups. Conclusion: Although safe, steroid treatment prior to TAVI failed to reduce the incidence of new conduction defects and the need for pacemaker implantation.

Original languageEnglish
Pages (from-to)325-329
Number of pages5
JournalCardiovascular Therapeutics
Volume34
Issue number5
DOIs
StatePublished - 1 Oct 2016

Keywords

  • Arrhythmias
  • Interventional cardiology
  • Valvular heart disease
  • Vascular biology

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