Interatrial block development in patients undergoing tavi and its relationship with clinical parameters

AIM: Determination of interatrial block occurence and related factors in patients who have undergone Transcatater Aortic Valve Implantation (TAVI) and who were successfully discharged. MATERIAL AND METHOD: : 90 patients who underwent TAVI in our clinic between 2015 and 2020 and were successfully discharged were analyzed retrospectively. General demographic data of the patients before the operation, electrocardiograms (ECG) before the procedure, follow-up ECGs and echocardiographs were scanned from the system. ECG measurements were made with the assistance of SEMA Workstation 3.8.1 (Schiller AG). Presence and level of interatrial block in ECG, P wave duration, pre-procedure echocardiography (ECO) findings (maximum, mean gradients, left atrium (LA) diameter), valve size and valve type used, interatrial ECG at 6 months after the procedure. We examined clinical parameters that may be related to the presence and degree of block, ECHO evaluation and development of interatrial block. FINDINGS: In the study, 46 patients who had TAVI between 2015 and 2020 and met the inclusion criteria were included in the study. The mean age of the patients was 74.78 ± 8.66. Partial interatrial block was observed in 17 (37%) of the ECGs evaluated preoperatively, and advanced interatrial block was observed in 3 (6.5%), 26 (56.5%) had no interatrial conduction abnormality. Of the postoperative ECGs, 14 (30.4%) had partial interatrial block, 10 (21.7%) had advanced interatrial block, 22 (47.8%) had no interatrial block. In the preoperative and postoperative evaluations, a significant difference was observed in the ECG in terms of interatrial block occurence (P = 0.017). Salfexpandable valves were used in 25 (54.3%) patients, and balloon expandable valves were used in 21 (45.7%) patients. In the preop ECG of 25 patients with self-expandable valves, 16 had no interatrial block, 7 had partial interatrial block, and 2 had advanced interatrial block. In the postop ECG of 25 patients with a self-expandable valve; 16 patients without interatrial block remained the same, 4 (57.1%) of 7 patients with partial interatrial block remained the same, 3 (42.9%) progressed to severe interatrial block, 1 out of 2 patients with advanced interatrial block (%) 50) regressed to partial interatrial block, while 1 (50%) remained the same. In the preop ECG of 21 patients with balloon expandable valves, 10 patients did not have interatrial block, 10 patients had partial interatrial block, 1 patient had advanced interatrial block. In the postop ECG of 21 patients with balloon expandable valves; Of 10 patients without interatrial block, 5 (50%) remained the same, 5 (50%) progressed to partial interatrial block (p = 0.022), a statistically significant difference was observed. While 4 (40%) of 10 patients with partial interatrial block remained the same, interatrial block was not observed in 1 (10%), 5 (50%) of them progressed to advanced interatrial block (p = 0.022), a statistically significant difference was observed. One patient with preop advanced interatrial block remained the same. In 21 patients with balloon expandable valves, the preoperative P wave duration was 127.62 ± 19.4, the post-procedure p wave duration was measured as 138.71+ 32.03. A statistically significant difference was observed (p = 0.038). CONCLUSION: In the patients who underwent TAVI, the ECGs checked in the 6th month showed that interatrial block occured and it's level increased after TAVI; It was observed that the development of interatrial block and the progress of the level of the existing interatrial block were higher in patients using balloon expandable valves. While the P wave duration did not change in the total patient population, it was found that the P wave duration was prolonged in patients with balloon expandable valves. It was thought that the mean gradient mean in balloon expandable valve was higher than those with self expandable valve and this may be related to the development of interatrial block, which is more common in balloon expandable valves.