395 ASSESSMENT OF VENTRICULAR ARRHYTHMIAS IN PATIENTS UNDERGOING TRANCATHETER AORTIC VALVE IMPLANTATION (TAVI): IMPACT ON CLINICAL OUTCOME


 
 
 Transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis has considerably grown in the latest years. There are limited data, however, about predictors of long-term prognosis in this population. Particularly, whether arrhythmic burden is associated with clinical outcome has poorly been investigated.
 
 
 
 We performed 24-hour 3-channel ECG Holter recording (HM) in 284 consecutive patients who underwent TAVI for severe aortic stenosis at our Center within 30 days from a successful procedure (average 10.2 days, range 2-30). For each patient we obtained the number of premature ventricular complexes (PVCs) and the presence of non-sustained ventricular tachycardia (NSVT, ≥3 PVCs with a rate ≥100 bpm). Assessment of clinical events at follow-up was performed by clinical visits or telephone interview of patients or relatives (in case of fatal events). The primary end-point of the study was a composite of cardiovascular death and resuscitation from cardiac arrest (CVE); total mortality was assessed as secondary end-point.
 
 
 
 Frequent PVCs (≥30/hour) and episodes of NSVT were found in 49 (20.2%) and 52 (21.4%) patients, respectively. Clinical outcome was obtained for 243 patients (85.6%). At an average follow-up of 3.5 year (range 1.0-8.6), CVE occurred in 25 patients (8.8%) and 64 died (22.5%). Frequent PVCs at HM were detected in 11/25 (44.0%) and 38/218 (17.4%) patients with and without CVE, respectively (p=0.006). Episodes of NSVT were detected in 9/25 (36.0%) and 43/218 (19.7%) patients with and without CVE, respectively (p=0.07). Furthermore, frequent PVCs were present in 18/64 (28.1%) and 31/179 (17.3%) patients dead and alive, respectively (p=0.07), whereas NSVT episodes were detected in 17/64 (26.6%) and 35/179 (19.6%) patients dead and alive, respectively (p=0.29). Frequent PVCs maintained independent association with CVE after correction for confounding variables at multivariable analysis (HR 2.63; 95 CI 1.05-6.62; p=0.04).
 
 
 
 Our data indicate that assessment of ventricular arrhythmic burden after TAVI is helpful to identify patients at increased risk of cardiovascular death/cardiac arrest during medium follow-up.
