ABSTRACT
Background
No data exist on the clinical and prognostic significance of syncope in patients undergoing
transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Methods
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.
Results
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.
Conclusions
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
Graphical Abstract
KEYWORDS
ABBREVIATIONS:
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)To read this article in full you will need to make a payment
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REFERENCES
- Burden of valvular heart diseases: a population-based study.Lancet. 2006; 368: 1005-1011
- Future of transcatheter aortic valve implantation - evolving clinical indications.Nat Rev Cardiol. 2018; 15: 57-65
- Risk stratification of patients with aortic stenosis.Eur Heart J. 2010; 31: 416-423
- Aortic stenosis.Circulation. 1968; 38: 61-67
- Syncope: The Underestimated Threat in Severe Aortic Stenosis.JACC Cardiovasc Imaging. 2019; 12: 225-232
- Hemodynamic determinants of dyspnea improvement in acute decompensated heart failure.Circ Heart Fail. 2013; 6: 53-60
- Determinants of ejection performance in aortic stenosis.Circulation. 1981; 64: 126-134
- Asymptomatic aortic stenosis in the elderly: a clinical review.JAMA. 2013; 310: 1490-1497
- Syncope in aortic valvular stenosis.Lancet. 1984; 2: 1113-1116
- Prevalence and Prognostic Relevance of Ventricular Conduction Disturbances in Patients With Aortic Stenosis.Am J Cardiol. 2017; 120: 2226-2232
- Ventricular arrhythmias in adult aortic stenosis: prevalence, mechanisms, and clinical relevance.Chest. 1998; 113: 482-491
- Arrhythmias in patients with valvar aortic stenosis, valvar pulmonary stenosis, and ventricular septal defect. Results of 24-hour ECG monitoring.Circulation. 1993; 87: I89-101
Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-1948.
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2).Eur J Cardiothorac Surg. 2012; 42: S45-60
- Hemodynamic patterns for symptomatic presentations of severe aortic stenosis.JACC Cardiovasc Imaging. 2013; 6: 137-146
- Effect of aging on baroreflex function in humans.Am J Physiol Regul Integr Comp Physiol. 2007; 293: R3-R12
- Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement.JAMA Intern Med. 2019; 179: 383-391
Mautner RK, Phillips JH. Atrioventricular and intraventricular conduction disturbances in aortic valvular disease. South Med J 1980;73:572-578, 81.
- Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement.Circulation. 2015; 131: 469-477
- Prolonged Continuous Electrocardiographic Monitoring Prior to Transcatheter Aortic Valve Replacement: The PARE Study.JACC Cardiovasc Interv. 2020; 13: 1763-1773
- Syncope in Patients With Severe Aortic Stenosis: More Than Just an Obstruction Issue.Can J Cardiol. 2021; 37: 284-291
WM Y. Heart block due to calcareous lesions of the bundle of His: review and report of a case with detailed histopathologic study. In: VH C, ed.: Ann Intern Med. 1935:777-789.
- Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement.Circulation. 1989; 79: 744-755
Article info
Publication history
Accepted:
February 13,
2023
Received in revised form:
January 30,
2023
Received:
December 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Syncope in Patients with Aortic Stenosis: Does Investigating the Cause Affect Prognosis?Canadian Journal of Cardiology
- PreviewWe read with great interest the recently published article by Keller et al. entitled "Syncope in Patients with Severe Aortic Stenosis (SAS) Undergoing Transcatheter Aortic Valve Replacement (TAVR)" in the Canadian Journal of Cardiology[1]. First of all, we congratulate the authors for their contribution to the understanding of the role of aortic stenosis in the etiology of syncope.
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