Sites of conduction disease in aortic stenosis. Significance of valve gradient and calcification

Electrophysiologic studies were done in 32 patients with aortic stenosis. In 24 patients with intact A-V conduction, A-H intervals ranged from 55 to 145 msec and were prolonged in two. Two had split His bundle potentials. The H-V intervals ranged from 25 to 94 msec and were prolonged in 12. The mean H-V interval was 63 ± 2.6 msec in 12 patients with calcific aortic stenosis compared with 50 ± 4.9 msec in 12 without calcification (P < 0.05). The mean H-V in 10 patients with aortic gradients > 40 mm Hg was 62 ± 5.6 msec compared with 47 ± 3.1 msec in nine with gradients < 40 (P < 0.05). In patients with aortic stenosis and A-V block, the site of the block was distal to the His bundle in three and within the His bundle in five. All eight had calcified valves. Aortic stenosis was commonly associated with latent and manifest conduction disease in the His bundle and the trifascicular conduction system. Conduction disease was more extensive with calcified valves and greater valve obstruction.