Predictors of Electrical Abnormalities Related to Mechanical Trauma during Transcatheter Aortic Valve Implantation

Background: When it came to treating patients with severe symptomatic aortic stenosis (AS) who are at high or prohibitive surgical risk, transcatheter aortic valve implantation (TAVI) marked a paradigm change. TAVI has become a safe technique with predictable results as a result of the expanding expertise in this sector, which has also reduced the risk of problems over time and increased the use of a minimalist approach. The incidence of conduction disturbances, such as bundle branch blocks or atrioventricular blocks necessitating pacemaker implantation, has not decreased recently, in contrast to other procedural complications.
Methods: This observational study included 80 patients with symptomatic severe AS who underwent transfemoral TAVI. Patients were divided based on the development of post-TAVI conduction abnormalities into two groups. Group I (n=70) without conduction abnormalities and group II (n = 10) developed new-onset conduction abnormalities.
Results: Depth of implantation at the membranous septum (DIMS) revealed a significant AUC of 0.935 with a 95% confidence interval ranging from 0.866 to 1.000, suggesting an excellent ability to predict conduction abnormalities. The best cutoff was > 64 mm, at which sensitivity, specificity, PPV, and NPV were 90.0%, 87.14%, 50.0%, and 98.4% respectively. ΔMSID demonstrated a significant AUC of 0.936 with a 95% confidence interval ranging from 0.838 to 1.000, indicating excellent predictive ability. The best cutoff point was ≤2 mm, at which sensitivity, specificity, PPV, and NPV were 80.0%, 98.57%, 88.9%, and 97.2% respectively.
Conclusions: Conduction disturbances remain a common complication of TAVI. Presence of RBBB is a risk factor that increases patient propensity for developing such complications post TAVI. The relationship between depth of implantation and membranous septum is a strong independent procedural predictor and prospective validation of its cut-offs is needed.