TY - JOUR
T1 - Steroid therapy and conduction disturbances after transcatheter aortic valve implantation
AU - Havakuk, Ofer
AU - Konigstein, Maayan
AU - Ben Assa, Eyal
AU - Arbel, Yaron
AU - Abramowitz, Yigal
AU - Halkin, Amir
AU - Bazan, Samuel
AU - Shmilovich, Haim
AU - Keren, Gad
AU - Finkelstein, Ariel
AU - Banai, Shmuel
N1 - Publisher Copyright:
© 2016 John Wiley & Sons Ltd
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - Arrhythmias
KW - Interventional cardiology
KW - Valvular heart disease
KW - Vascular biology
UR - http://www.scopus.com/inward/record.url?scp=84991078941&partnerID=8YFLogxK
U2 - 10.1111/1755-5922.12202
DO - 10.1111/1755-5922.12202
M3 - Article
C2 - 27273567
AN - SCOPUS:84991078941
SN - 1755-5914
VL - 34
SP - 325
EP - 329
JO - Cardiovascular Therapeutics
JF - Cardiovascular Therapeutics
IS - 5
ER -