HV Electrophysiology Study In Transcatheter Aortic Valve Implantation Patients

Study Overview
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Brief Summary
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TAVI induced LBBB is a complication that occurs between 7 and 65 % of the cases, numbers that differ considerably between devices. There is an increased risk of progression to total AV-block at follow-up, with the risk of brady-arrhythmic death. The aim of the study is to elucidate the anatomical location of the conduction pathology of a TAVI induced LBBB. This could impact valve design and placement and thereby reduce the number of new LBBB induced by TAVI in the future. Furthermore, finding predictors for progression to a high degree AV block in the follow-up (and thus an indication for permanent pacemaker) could improve management of post-operative conduction abnormalities and prevent the risk of brady-arrhythmic death.

Detailed Description
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A prospective, single center, non-randomized pilot study in which patients will undergo an electrophysiology (EP) study during the TAVI procedure. All patients eligible for inclusion will undergo an electrophysiology (EP) study during the TAVI procedure. For the purpose of EP measurements, a His-catheter will be placed at the beginning of the procedure and remain in the same location until the end of the procedure. Continuous HV measurements will be collected, together with a continuous surface ECG, during the entire TAVI procedure. The different steps in TAVI procedure will be registered. During the study, patients will undergo regular electrocardiographic examinations at the outpatient clinic (before implantation, after implantation, before discharge and after 6 weeks, 6 and 12 months post-implantation). These are part of the standard healthcare after the TAVI procedure. The research protocol has been approved by the ethical committee (METC).

Official Title
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HV Electrophysiology Study In Transcatheter Aortic Valve Implantation Patients

Conditions
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Left Bundle Branch Block, Transcatheter Aortic Valve Replacement, Transcatheter Aortic Valve Implantation

Intervention / Treatment
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* Other: HV measurement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients must provide written informed consent Exclusion Criteria: Pre-existent LBBB Pre-existent sick sinus syndrome Pre-existent high-degree atrioventricular block Pre-existent permanent pacemaker Patients unable to provide written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: HV measurement|Electrophysiology (EP) study during the TAVI procedure|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of a conduction disturbance in the His-bundle on occurence of a left bundle branch block on surface electrocardiogram by registering the HV-time in milli-seconds during the TAVI procedure. | Evaluate the location of a LBBB. | 2 hours (from beginning to the end of TAVI procedure) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Persistency and/or progression of a TAVI induced LBBB by registering the presence of a LBBB or a high degree AV block (second degree AV block or complete AV block) on surface electrocardiogram (ECG). |  | at 1 day before TAVI procure, at 1 hour after TAVI procedure, at discharge, at 6 weeks, at 6 months, at 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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LBBB, TAVI