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Vol. 77. Issue 1.
Pages 29-38 (January 2024)
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Vol. 77. Issue 1.
Pages 29-38 (January 2024)
Original article
Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes
TAVI autoexpandible con superposición de senos coronarios frente a la técnica tradicional: alteraciones en el ECG y eventos cardiovasculares al año
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Yván R. Persia-Paulinoa,, Marcel Almendarez Lacayoa,b,, Alberto Alperia,b,, Daniel Hernández-Vaqueroa,b, Rodrigo Fernández Asensioa, Javier Cuevas Péreza, Antonio Adebaa, Pablo Flórezc, María Vigil-Escalerad, Rut Álvarez Velascoa,b, Alfredo Renillae, Raquel del Valle Fernándeza, Paula Antuñaa, César Morís de la Tassaa,b,f, Pablo Avanzasa,b,f,g,
Corresponding author
, Isaac Pascuala,b,f
a Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
c Servicio de Cardiología, Hospital Valle del Nalón, Langreo, Asturias, Spain
d Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
e Servicio de Cardiología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
f Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
g Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Tables (5)
Table 1. Baseline characteristics of the patients included in the study prior to propensity score matching
Table 2. Baseline characteristics of patients included in the study matched by propensity score
Table 3. Changes in duration or voltage of the different ECG waves and intervals
Table 4. Comparison of intraventricular and atrioventricular conduction disturbances after the procedure and at 1 year
Table 5. One-year comparison of events in the TT and COT groups
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Additional material (1)
Abstract
Introduction and objectives

Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up.

Methods

Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year.

Results

We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005).

Conclusions

At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.

Keywords:
Transcatheter aortic valve replacement
Valve implantation
Pacemaker
Artificial cardiac pacing
Cardiovascular adverse effects
Electrocardiography
Abbreviations:
AVB
LBBB
ECG
TAVI
COT
TT
Resumen
Introducción y objetivos

El implante percutáneo de válvula aórtica (TAVI) mediante la técnica de superposición de senos coronarios (TSSC) ha mostrado una menor tasa de implante de marcapasos a 30 días. El objetivo de este estudio es comparar las alteraciones en el electrocardiograma y los eventos clínicos entre la TSSC y la técnica tradicional (TT) al año de seguimiento.

Métodos

Estudio observacional, retrospectivo y no aleatorizado de pacientes consecutivos sometidos a TAVI entre enero de 2015 y enero de 2021. Las características basales se emparejaron por propensión. Se compararon la TT y la TSSC. Los objetivos primarios fueron los cambios electrocardiográficos y un combinado de implante de marcapasos, hospitalización y muerte cardiovascular al año de seguimiento.

Resultados

Se incluyó a 254 pacientes y, tras el emparejamiento por propensión, se evaluó a 184 (92 por grupo). No hubo diferencias estadísticamente significativas en las características basales. Con la TSSC hubo una reducción significativa de la incidencia del bloqueo de rama izquierda del haz de His (el 49 frente al 27%; p=0,002), así como una menor prolongación de la onda P (13,1±21,0 frente a 5,47±12,5 ms; p=0,003) y del QRS (29,77±27,0 frente a 16,38±25,4 ms; p<0,001). La TSSC se asoció con una significativa reducción del objetivo combinado (sHR=0,39; IC95%, 0,21-0,76; p=0,005).

Conclusiones

Al año de seguimiento, el TAVI mediante TSSC produce menor incidencia de bloqueo de rama izquierda y un menor ensanchamiento del QRS y la onda P en comparación con la TT. La TSSC se asoció con una reducción estadísticamente significativa del evento primario combinado cardiovascular.

Palabras clave:
Implante percutáneo de válvula aórtica
Implante valvular
Marcapasos
Estimulación cardiaca artificial
Eventos cardiovasculares
Electrocardiografía

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