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Steroid Therapy and Conduction Disturbances after Transcatheter Aortic Valve Implantation.

Research paper by Ofer O Havakuk, Maayan M Konigstein, Eyal E Ben Assa, Yaron Y Arbel, Yigal Y Abramowitz, Amir A Halkin, Samuel S Bazan, Haim H Shmilovich, Gad G Keren, Ariel A Finkelstein, Shmuel S Banai

Indexed on: 09 Jun '16Published on: 09 Jun '16Published in: Cardiovascular Therapeutics



Abstract

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 pre-procedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI.From a cohort of 324 patients who underwent trans-femoral TAVI, 39 (12%) were pre-treated 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% versus 37.5%, and 25.6% versus 25.3%, respectively). New conduction disturbances were more prevalent in patients treated with CoreValve prosthesis, low implantation and smaller aortic annulus diameter (p<0.001, p<0.001 and p=0.006 respectively). Thirty day mortality and complication rates were similar between the groups.Although safe, steroid treatment prior to TAVI failed to reduce the incidence of new conduction defects and the need for pacemaker implantation. This article is protected by copyright. All rights reserved.

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