JCCVS

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

EndNote Style
Index
Original Article
Interatrial blocks in patients with tavi and their associations with clinic parameters
Aims: The present study attempted to evaluate the prevalence of basal interatrial blocks (IABs), their associations with clinical parameters, and the interatrial conduction in the follow-up after a successful transcatheter aortic valve implantation (TAVI) procedure among patients with severe aortic stenosis.
Methods: We retrospectively evaluated the findings of 90 patients undergoing TAVI in our center. Overall, we considered the presence and grades of IABs and P-wave durations in electrocardiograms (ECG), preoperative echocardiography (ECHO) findings (maximum and mean gradients and left atrium (LA) diameter), valve size and type, and changes in these parameters at sixth month.
Results: Forty-six patients were included in the study which are suitable for the pre-determined inclusion criteria. We found the mean age of the patients to be 74.78 ± 8.66 years. In preoperatively-evaluated ECGs, while we detected partial IABs in 37% of the patients, there were advanced IABs in 6.5%, but 56.5% yielded no interatrial conduction disorder. On the other hand, in postoperatively-evaluated ECGs, while we observed partial IABs in 30.4% of the patients, there were advanced IABs among 21.7% (p = 0.017). Nevertheless, we could not conclude any IABs among 47.8% of the patients. Besides, 54.3% of the patients received a self-expandable valve, and a balloon-expandable valve was inserted in 45.7%. In this regard, we detected partial (7 patients) and advanced (2 patients) IABs in the preoperatively-evaluated ECGs of the patients receiving a self-expandable valve. In the postoperative ECGs of these patients, while the partial IAB remained the same in 4 patients (57.1%), it progressed to an advanced IAB in 3 (42.9%). In addition, while the advanced IAB regressed to a partial IAB in one patient, it remained the same for the other patient. In this group, the mean P-wave durations were found to be 118.4±22.67 before the TAVI and 119.6±21.69 after the TAVI (p = 0.113). In the preoperative ECGs of 21 patients with a balloon-expandable valve, we detected partial IABs in 10 patients and an advanced IAB in one patient. While a partial IAB developed in five patients (p = 0.022), five patients with a partial IAB developed an advanced IAB following the procedure (p = 0.022). In this group, we noticed a significant difference between preoperative (127.62±19.4) and postoperative (138.71+ 32.03) P-wave durations (p = 0.038).
Conclusion: In a nutshell, we concluded no significant change in interatrial conduction time of the patients with TAVI compared to the baseline in their sixth-month ECGs. When considered by valve type, we concluded that the development and progression of IABs were significant among those with a balloon-expandable valve. The higher postoperative mean gradient among those with a balloon-expandable valve compared to those with a self-expandable valve may be associated with significantly longer P-wave duration among those with a balloon-expandable valve.


1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheterimplantation of an aortic valve prosthesis for calcific aortic stenosis:first human case description. Circulation. 2002;106(24):3006-3008.
2. De Luna AB. Clinical electrocardiography: a textbook. New York,Futura, 1998: p. 169-171.
3. Amato MCM, Moffa PJ, Werner KE, Ramires JAF. Treatment decisionin asymptomatic aortic valve stenosis: role of exercise testing. Heart.2001;86(4):381-386.
4. Minners J, Allgeier M, Gohlke-Baerwolf C, Kienzle RP, Neumann FJ,Jander N. Inconsistencies of echocardiographic criteria for the gradingof aortic valve stenosis. Eğur Heart J. 2008;29(8):1043-1048.
5. De Luna AB, Platonov P, Cosio FG, et al. Interatrial blocks. A separateentity from left atrial enlargement: a consensus report. J Electrocardiol.2012;45(5):445-451.
6. De Luna AB, Guindo J, Viñolas X, Martinez-Rubio A, Ote, R, Bayes-Genis A. Third-degree inter-atrial block and supraventriculartachyarrhythmias. EP Europace. 1999;1(1):43-46.
7. Martínez-Sellés M, Robledo LA, Baranchuk A. Interatrial block and therisk of ischemic stroke. J Atheroscler Thromb. 2017;24(2):185-186. doi:10.5551/jat.37242.
8. Vicent L, Fernández-Cordón C, Nombela-Franco L, et al. BaselineInteratrial Block and Transcatheter Aortic Valve Implantation (BIT)Registry Investigators †. Baseline ECG and prognosis after transcatheteraortic valve implantation: the role of interatrial block. J Am HeartAssoc. 2020 Nov 17;9(22):e017624. doi: 10.1161/JAHA.120.017624.
9. Martínez-Sellés M, Escobar-Robledo LA, Bernal E, et al. Rational anddesign of the baseline interatrial block and transcatheter aortic valveimplantation (BIT) registry. J Electrocardiol. 2019;57:100-103. doi:10.1016/j.jelectrocard.2019.09.016
10. Carrillo-Loza K, Baranchuk A, Serrano F, et al. Advanced interatrialblock predicts recurrence of embolic stroke of undetermined source. published online ahead of print, 2019 Dec 30
11. O’Neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: the atherosclerosis risk incommunities study. eurology. 2016;87(4):352-356.
12. Cotter PE, Martin PJ, Ring L, Warburton EA, Belham M, Pugh PJ.Incidence of atrial fibrillation detected by implantable loop re cordersin unexplained stroke. Neurology. 2013;80(17):1546-1550.
13. Cotter PE, Martin PJ, Pugh PJ, Warburton EA, Cheriyan J, BelhamM. Increased incidence of interatrial block in younger adults withcryptogenic stroke and patent foramen ovale. Cerebrovasc Dis Extra.2011;1(1):36-43.
14. Enriquez A, Sarrias A, Villuendas R, et al. New-onset atrial fibrillationafter cavotricuspidisthmus ablation: identification of advancedinteratrial block is key. EP Europace. 2015;17(8):1289-1293.
15. Çinier G, Tekkeşin Aİ, Genç D, et al. Interatrial block as a predictorof atrial fibrillation in patients with ST-segment elevation myocardialinfarction. Clin Cardiol. 2018;41(9):1232-1237.
Volume 1, Issue 1, 2023
Page : 5-9
_Footer