TCT-903 Incidence and Predictors of Left Bundle Branch Block after Transcatheter Aortic Valve Implantation (original) (raw)

2012, Journal of the American College of Cardiology

Background: To compare the incidence and clinical significance of new bundle branch block in patients undergoing transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve and Edwards-Sapien prosthesis. Methods: We analyzed data from 336 patients (pts) with no prior pacemaker who underwent TAVI with CoreValve (nϭ130) or Edwards (nϭ206) prosthesis between 2007 and 2011 in our centre. We examined the 12-lead ECGs and documented the conduction disturbances after TAVI and before discharge as compared to baseline. Results: Mean age was similar in CoreValve (79.4Ϯ7.3 years) vs. Edwards group (79.7Ϯ8.1 years, pϭ0.43). New onset of left bundle branch block (LBBB) was documented in 65 (19.3%) pts: 21 (32.2%) in Edwards vs. 44 (67.7%) in CoreValve pts (pϭ0.001). Of them 18 (27.7%) pts showed also a 1st atrioventricular block (AVB): 3 in Edwards and 16 in CoreValve pts (pϭ0.001). Permanent Pacemaker implantation (PPM) was required in 9 (13.8%) pts because of 3rd AVB (Edwards nϭ3; CoreValve nϭ4), LBBB and 1st AVB (CoreValve nϭ1) and LBBB with sinus bradycardia (CoreValve nϭ1). In 14 (21.5%) pts, LBBB was temporary (5 pts, 23.8% Edwards vs. 9pts, 20.4% CoreValve), whereas LBBB persisted in 61.9% of Edwards and in 65.9% of CoreValve pts (pϭ0.5) at discharge. On multivariable analysis, the predictors of LBBB were: CoreValve prosthesis (OR:5.3 95%-CI:2.9-9.8, pϽ0.001), and previous CABG (OR:1.9, 95%-CI:0.9-4, pϽ0.064). New onset of LBBB was not a predictor of overall (log rank pϭ0.56) and cardiovascular mortality (log rank pϭ0.61). A new onset of right bundle branch block (RBBB) was documented in 12 (3.6%) pts (6 both in Edwards and in CoreValve pts): 1.5% with left anterior hemiblock (LAH), 0.3% with 1st AVB and 0,6% with both LAH and 1st AVB. There were no statistically significant differences between Edwards and CoreValve prosthesis. 9 pts developed a new isolated 1st AVB. Conclusions: New LBBB and RBBB are frequent intraventricular conduction disturbances after TAVI with a higher incidence in CoreValve prosthesis. In the majority of pts, the LBBB persists but is not a predictor of overall and cardiovascular mortality. These preliminary conclusions needs to be confirmed in a lorger cohort of patients.