Author + information
- Received April 22, 2012
- Revision received June 27, 2012
- Accepted July 2, 2012
- Published online October 30, 2012.
- Marina Urena, MD⁎,
- Michael Mok, MD⁎,
- Vicenç Serra, MD†,
- Eric Dumont, MD⁎,
- Luis Nombela-Franco, MD⁎,
- Robert DeLarochellière, MD⁎,
- Daniel Doyle, MD⁎,
- Albert Igual, MD†,
- Eric Larose, MD⁎,
- Ignacio Amat-Santos, MD⁎,
- Mélanie Côté, MSc⁎,
- Hug Cuéllar, MD†,
- Philippe Pibarot, PhD⁎,
- Peter de Jaegere, MD, PhD‡,
- François Philippon, MD⁎,
- Bruno Garcia del Blanco, MD† and
- Josep Rodés-Cabau, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, G1V 4G5 Quebec City, Quebec, Canada
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 high-degree 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 = 0.037) and ventricular depth of the prosthesis (p = 0.017) were independent predictors of persistent LBBB. Persistent LBBB at hospital discharge was associated with a decrease in left ventricular ejection fraction (p = 0.001) and poorer functional status (p = 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 = 0.001) and complete AVB requiring PPI (20.0% vs. 0.7%; p < 0.001), but not of global mortality or cardiac mortality during the follow-up period (all, p > 0.20). New-onset LBBB was the only factor associated with PPI following TAVI (p < 0.001).
Conclusions Up to 30% of patients with no prior conduction disturbances developed new LBBB following TAVI with a balloon-expandable 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.
- conduction disturbances
- left bundle branch block
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Urena has received a grant from the Spanish Society of Cardiology. Dr. Rodés-Cabau is a consultant for Edwards Lifesciences Inc. and St-Jude Medical. Dr. Delarochellière is a consultant for St-Jude Medical. Dr. Dumont is a consultant for Edwards Lifesciences Inc. Dr. de Jaegere is proctor for Medtronic Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 22, 2012.
- Revision received June 27, 2012.
- Accepted July 2, 2012.
- American College of Cardiology Foundation