Comparison of Incidence and Predictors of Left Bundle Branch Block After Transcatheter Aortic Valve Implantation Using the CoreValve Versus the Edwards Valve (original) (raw)
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Europace, 2017
Transcatheter aortic valve implantation (TAVI) is frequently associated with cardiac conduction defects (CCD) requiring permanent pacemaker implantation (PPI). Although new-onset left bundle branch block (LBBB) is often seen, the rate of progression to severe CCD is unclear. We aimed to find clinical and electrocardiographic (ECG) parameters associated with severe CCD requiring PPI in patients with a new-onset LBBB after TAVI and assess its effect on clinical outcome. Methods and results All consecutive patients undergoing TAVI who developed a new-onset LBBB were retrospectively analysed. We excluded patients with pre-existing bundle branch block or pacemaker. Patients were divided into two groups: with or without PPI after TAVI. We included 155 patients (50% female, 80 + 7 years), of which 37 (24%) developed CCD requiring PPI, mainly due to a total atrioventricular block (n ¼ 17; 46%). Cardiac conduction defects requiring PPI were associated with the following pre-existing parameters: atrial fibrillation (AF), the use of digoxin, CoreValve implantation, and left heart axis. Furthermore, it was associated with the following post-procedural parameters: left heart axis, lower mean heart rate, and prolonged PQ and QRS times. During follow-up, patients with PPI showed a lower mortality rate (11 vs. 29%, P ¼ 0.03). In patients without PPI, mortality was lower in those with narrower QRS complex and transient LBBB. Conclusion The severity and persistence of a new-onset LBBB after TAVI is associated with mortality. Cardiac conduction defects requiring PPI are associated with prior AF, the use of digoxin, CoreValve implantation, and a left heart axis. In these patients, PPI portends a better prognosis than no PPI.
BMJ open, 2016
Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His-ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV <70 ms) will be implanted with a loop recorder device with remote monitoring of cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and implanted device follow-up will also...
American Journal of Cardiology, 2016
New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n [ 80), those with persistent new-onset LBBB, and group 2 (n [ 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32-22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p [ 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p [ 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p [ 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.
Journal of the American College of Cardiology, 2012
Objectives This study evaluated the predictive factors and prognostic value of new-onset persistent left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve implantation (TAVI) with a balloon-expandable valve. Background The predictors of persistent (vs. transient or absent) LBBB after TAVI with a balloon-expandable valve and its clinical consequences are unknown. Methods A total of 202 consecutive patients with no baseline ventricular conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent TAVI with a balloon-expandable valve were included. Patients were on continuous electrocardiographic (ECG) monitoring during hospitalization and 12-lead ECG was performed daily until hospital discharge. No patient was lost at a median follow-up of 12 (range: 6 to 24) months, and ECG tracing was available in 97% of patients. The criteria for PPI were limited to the occurrence of highdegree atrioventricular block (AVB) or severe symptomatic bradycardia. Results New-onset LBBB was observed in 61 patients (30.2%) after TAVI, and had resolved in 37.7% and 57.3% at hospital discharge and 6-to 12-month follow-up, respectively. Baseline QRS duration (p ϭ 0.037) and ventricular depth of the prosthesis (p ϭ 0.017) were independent predictors of persistent LBBB. Persistent LBBB at hospital discharge was associated with a decrease in left ventricular ejection fraction (p ϭ 0.001) and poorer functional status (p ϭ 0.034) at 1-year follow-up. Patients with persistent LBBB and no PPI at hospital discharge had a higher incidence of syncope (16.0% vs. 0.7%; p ϭ 0.001) and complete AVB requiring PPI (20.0% vs. 0.7%; p Ͻ 0.001), but not of global mortality or cardiac mortality during the follow-up period (all, p Ͼ 0.20). New-onset LBBB was the only factor associated with PPI following TAVI (p Ͻ 0.001). Conclusions Up to 30% of patients with no prior conduction disturbances developed new LBBB following TAVI with a balloonexpandable valve, although it was transient in more than one third. Longer baseline QRS duration and a more ventricular positioning of the prosthesis were associated with a higher rate of persistent LBBB, which in turn determined higher risks for complete AVB and PPI, but not mortality, at 1-year follow-up.
Circulation, 2013
T ranscatheter aortic valve implantation (TAVI) is now recognized as a valid option in patients with severe aortic stenosis deemed at high or prohibitive risk for conventional surgical aortic replacement. 1,2 Recent publication of several national registries contributed significantly to the understanding of possible factors associated with or predictive of adverse prognosis. 3-6 Some of these factors, such as older age, critical preoperative state, renal failure, and the presence of multiple comorbidities, are common predictors of adverse outcome even after surgical aortic valve replacement. Clinical Perspective on p XXX
JACC: Cardiovascular Interventions, 2014
Objectives The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of NOP-LBBB after TAVI remains controversial. Methods A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. Results New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p ¼ 0.54). There were no differences between groups regarding cardiovascular mortality (p ¼ 0.82), sudden death (p ¼ 0.87), rehospitalizations for all causes (p ¼ 0.11), or heart failure (p ¼ 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). Conclusions NOP-LBBB occurred in w1 of 10 patients who had undergone TAVI with a balloonexpandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.
Left Bundle Branch Block After Transcatheter Aortic Valve Implantation
JACC: Cardiovascular Interventions, 2014
Transcatheter aortic valve implantation (TAVI) has experienced unprecedented growth since its first description by Alain Cribier in 2002 (1) and is now routinely performed in many institutions worldwide. New-onset left bundle branch block (LBBB) or atrioventricular (AV) block necessitating permanent pacemaker implantation (PPI) are among the most frequent complications of TAVI (2-5). Case reports describing late occurrence of complete AV block and the fact that LBBB has been associated with a worse outcome after surgical aortic valve implantation led clinicians to adopt a generous strategy of pacemaker implantation after TAVI. This strategy was further enhanced by the urge to ambulate patients early after TAVI instead of prolonged monitoring for resolution of AV conduction impairment. Improvement
JACC. Cardiovascular interventions, 2018
The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR. This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treat...