Exposure to glucocorticoids prior to transcatheter aortic valve replacement is associated with reduced incidence of high-degree AV block and pacemaker

Brett Oestreich, Sergey Gurevich, Selcuk Adabag, Rosemary Kelly, Gregory Helmer, Ganesh Raveendran, Demetris Yannopoulos, Timinder Biring, Santiago Garcia

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4 Scopus citations

Abstract

Background: Tissue edema and inflammation, which occur at the device landing zone during valve deployment, may contribute to the pathophysiology of conduction abnormalities after transcatheter aortic valve replacement (TAVR). We hypothesized that exposure to glucocorticoids prior to TAVR will reduce the incidence of conduction abnormalities requiring PPM implantation after TAVR. Methods: We included 167 consecutive patients treated with TAVR at the Minneapolis VA Medical Center and University of Minnesota. Exposure to glucocorticoids was assessed by linking electronic medical and pharmacy records. The primary outcome was a new PPM within 30 days of the index TAVR procedure. Results: Of the 167 patients included, 16 (9.5%) were exposed to glucocorticoids prior to TAVR. No differences in age, STS score, pre-existing right bundle branch block, implantation depth or valve type were seen among patients exposed to glucocorticoids versus those who were unexposed. Patients exposed to glucocorticoids were more likely to have moderate/severe COPD (43% versus 18%, p < 0.01). The cumulative incidence of PPM implantation at 30-days after TAVR was 18%. None of the patients exposed to glucocorticoids required a PPM while 30 (19%) of the unexposed patients did (p = 0.04). Conclusions: Exposure to glucocorticoids prior to TAVR may be associated with reduced incidence of PPM requirement though larger studies are needed to support these findings. Tissue edema and inflammation may be significant contributors to the pathophysiology of conduction abnormalities after TAVR and could represent a therapeutic target.

Original languageEnglish (US)
Pages (from-to)328-331
Number of pages4
JournalCardiovascular Revascularization Medicine
Volume20
Issue number4
DOIs
StatePublished - Apr 2019

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  • Journal Article

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