Trastornos de la conducción e implante de marcapasos tras implante de válvula aórtica SAPIEN 3 comparada con la SAPIEN XT

Introduction and objectives Transcatheter aortic valve implantation is increasingly used in patients with aortic stenosis. Post-procedural intraventricular conduction abnormalities and permanent pacemaker implantations remain a serious concern. Recently, the Edwards SAPIEN 3 prosthesis has replaced the SAPIEN XT. We sought to determine the incidences of new-onset intraventricular conduction abnormalities and permanent pacemaker implantations by comparing the 2 devices. Methods We analyzed the last consecutive 103 patients undergoing transcatheter aortic valve implantation with SAPIEN XT before SAPIEN 3 was used in the next 105 patients. To analyze permanent pacemaker implantations and new-onset intraventricular conduction abnormalities, patients with these conditions at baseline were excluded. Electrocardiograms were recorded at baseline, after the procedure, and before discharge. Results SAPIEN 3 was associated with higher device success (100% vs 92%; P =.005) and less paravalvular leakage (0% vs 7%; P <.001). The incidence of permanent pacemaker implantation was 12.6% (23 of 183) with no difference between the 2 groups (SAPIEN 3: 12.5% [12 of 96] vs SAPIEN XT: 12.6% [11 of 87]; P =.99). SAPIEN 3 was associated with a higher rate of new-onset intraventricular conduction abnormalities (49% vs 27%; P =.007) due to a higher rate of fascicular blocks (17% vs 5%; P =.021). There was no statistically significant difference in transient (29% [20 of 69] vs persistent 19% [12 of 64]; P =.168) left bundle branch blocks (28% [19 of 69] vs 17% [11 of 64]; P =.154) when SAPIEN 3 was compared with SAPIEN XT. Conclusions We found a trend toward a higher rate of new-onset intraventricular conduction abnormalities with SAPIEN 3 compared with SAPIEN XT, although this did not result in a higher permanent pacemaker implantation rate. Full English text available from: www.revespcardiol.org/en.