Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation

Abstract

Background Left bundle branch block ( LBBB ) is common after transcatheter aortic valve implantation ( TAVI ) and is an indicator of subsequent high‐grade atrioventricular block ( HAVB ). No standardized protocol is available to identify LBBB patients at risk for HAVB . The aim of the current study was to evaluate the safety and efficacy of an electrophysiology study tailored strategy in patients with LBBB after TAVI . Methods and Results We prospectively analyzed consecutive patients with LBBB after TAVI . An electrophysiology study was performed to measure the HV ‐interval the day following TAVI . In patients with normal His‐ventricular ( HV )‐interval ≤55 ms, a loop recorder was implanted ( ILR ‐group), whereas pacemaker implantation was performed in patients with prolonged HV ‐interval >55 ms ( PM ‐group). The primary end point was occurrence of HAVB during a follow‐up of 12 months. Secondary end points were symptoms, hospitalizations, adverse events because of device implantation or electrophysiology study, and death. Of 373 patients screened after TAVI , 56 patients (82±6 years, 41% male) with LBBB were included. HAVB occurred in 4 of 41 patients (10%) in the ILR ‐group and in 8 of 15 patients (53%) in the PM ‐group ( P <0.001). We did not identify other predictors for HAVB than the HV interval. The negative predictive value for the cut‐off of HV 55 ms to detect HAVB was 90%. No HAVB ‐related syncope occurred in the 2 groups. Conclusions An electrophysiology study tailored strategy to LBBB after TAVI with a cut‐off of HV >55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow‐up of 12 months.

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

“…This hypothetical observation period may be shortened or lengthened according to patient-related factors and electrical findings. Once again, electrophysiological study may identify some high-risk patients for the development of high-grade atrio-ventricular disturbances and, thereby, adjust the observation rhythm period in such patients [ 71 ].…”

Value of Periprocedural Electrophysiology Testing During Transcatheter Aortic Valve Replacement for Risk Stratification of Patients With New‐Onset Left Bundle‐Branch Block

“…TAVR procedures were performed as previously described. 12 Briefly, transthoracic echocardiography, coronary angiography, and ECG‐triggered multislice computed tomography scan of the aorta were performed for procedural planning. The implantation of the valve was performed according to the recommendations of the manufacturer.…”

“…Performing EPS, most approaches stratify patients with LBBB after TAVR regarding the risk of development of HAVB based on predefined His‐ventricular (HV) interval cutoffs such as >55 milliseconds, 12 ≥65 milliseconds , 13 or ≥70 milliseconds. 11 Since periprocedural data are lacking, the optimal timing of the EPS, however, is not known.…”

“…In most studies, EPS was performed 24 to 48 hours after TAVR. 12 , 13 , 14 , 15 , 16 , 17 The new ESC guidelines for cardiac pacing state that EPS should be performed ≥3 days after the procedure and after the conduction abnormalities have stabilized. 11 It is unclear whether EPS immediately after TAVR would yield similar results.…”

Conduction Disturbances and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Predictors and Prevention

“…In patients with LBBB after TAVR, an HV < 55 ms has been shown to have a negative predictive value of 90% for high-grade heart block. 46 These studies give only a snapshot of the His-Purkinje conduction and HV intervals can be dynamic and can shorten in a matter of days postimplant. 47 While a prolonged HV > 65 ms is sensitive for development of heart block, it is not specific and so would result in a significant number of patients with underutilized pacemakers.…”