Canadian Journal of Cardiology
Clinical Research|Articles in Press

Syncope in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Published:February 18, 2023DOI:



      No data exist on the clinical and prognostic significance of syncope in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.


      A total of 1705 consecutive patients with severe aortic stenosis undergoing TAVR in a tertiary university center between 2007 and 2021 were included and classified according to the presence of syncope prior to the TAVR procedure. Baseline, procedural and follow-up data were collected prospectively in a dedicated database.


      A total of 115 patients (7%) presented syncope prior to the TAVR procedure. Of these, 15 patients (13%) showed an arrhythmic episode as the probable cause of the syncope, and all of them had a pacemaker implanted at a median of 13 (6-53) days prior to the TAVR procedure. Patients with prior syncope were older (82±8 years vs. 80±8 years, p=0.001), and had a higher rate of pacemaker implantation prior to the TAVR procedure (27% vs. 14%, p<0.001), with no differences between groups regarding aortic stenosis severity (transvalvular gradient, valve area). There were no differences between groups in 30-day (adjusted HR: 1.28, 95% CI: 0.46-3.60) and 1-year (adjusted HR: 0.71, 95% CI: 0.0.35-1.45) mortality following TAVR.


      Syncope was not associated with a more advanced valvular disease and had no significant prognostic impact in patients undergoing TAVR. However, arrhythmias and conduction system disturbances were more common in patients with previous syncope and might play a relevant role in the pathogenesis of syncope in aortic stenosis patients.

      Graphical abstract



      TAVR (Transcatheter aortic valve replacement), ECG (Electrocardiogram), SAVR (Surgical aortic valve replacement), LV (Left ventricle), LVEF (Left ventricular ejection fraction), LBBB (Left bundle branch block), AVB (Atrioventricular block)
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