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Patients with bicuspid aortic valves may be associated with infra-hisian conduction disease requiring pacemakers

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Bicuspid aortic valves (BAVs) are associated with accelerated valvular dysfunction. Increasing rates of conduction system disease are seen in patients with calcific tricuspid aortic valves (TAVs). However, little is known regarding the extent of conduction disorders in BAV patients. We sought to determine the extent of infra-hisian conduction pathology among patients with BAVs undergoing EP studies.

Methods

We prospectively analyzed patients presenting to the EP laboratory from 2006 to 2017 at our institution. Thirty-three BAV patients had measured HV intervals. Each individual was matched by age and gender to two control patients. Clinical characteristics were collected and compared, and patients followed for outcomes.

Results

The BAV cohort had a mean age of 47.8 ± 17.2 years (range 19–76 years). Indications for referral to the EP lab in the BAV cohort included SVT ablation (n = 16), VT ablation (n = 10), and EP study for syncope, pre-syncope, or palpitations (n = 29). Patients with BAVs had a mean HV interval of 58.7 ms ± 18.6 ms, compared to a mean of 47.2 ms ± 9.6 ms for controls (p value = 0.0001). Over a 10-year follow-up period, 9 BAV patients (27%) went on to require permanent pacing compared to 6 patients (9%) in the control group (p value = 0.03).

Conclusion

Compared to patients with TAVs presenting for EP evaluation, individuals with BAVs have longer HV intervals and a significantly increased requirement for pacemaker therapy over long-term follow-up. Closer monitoring of progressive conduction system disease in BAV patients may be warranted.

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Abbreviations

BAV:

Bicuspid aortic valve

EPS:

Electrophysiologic study

LV EF:

Left ventricular ejection fraction

SVT:

Supraventricular tachycardia

HV:

His-ventricular interval

HTN:

Hypertension

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Funding

Drs. Sauer and Nguyen receive significant research grants from Biosense Webster and CardioNXT and educational grants from St. Jude Medical, Boston Scientific, and Medtronic.

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Authors and Affiliations

  1. Department of Medicine, Cardiology Division, University of Colorado, Aurora, CO, USA

    Minakshi Biswas, Amneet Sandhu, Joseph D. Kay & Amber D. Khanna

  2. Department of Pediatrics, Cardiology Division, University of Colorado, Aurora, CO, USA

    Joseph D. Kay, Amber D. Khanna & Kathryn K. Collins

  3. Department of Medicine, Cardiology Division, Brigham and Women’s Hospital, Boston, MA, USA

    William H. Sauer

  4. Section of Cardiac Electrophysiology, Department of Medicine, Cardiology Division, Stanford University, 870 Quarry Road Extension, Stanford, CA, 94305, USA

    Duy T. Nguyen

Authors
  1. Minakshi Biswas
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  2. Amneet Sandhu
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  3. Joseph D. Kay
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  4. Amber D. Khanna
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  7. Duy T. Nguyen
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Correspondence to Duy T. Nguyen.

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Biswas, M., Sandhu, A., Kay, J.D. et al. Patients with bicuspid aortic valves may be associated with infra-hisian conduction disease requiring pacemakers. J Interv Card Electrophysiol 61, 29–35 (2021). https://doi.org/10.1007/s10840-020-00785-z

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  • DOI: https://doi.org/10.1007/s10840-020-00785-z

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