Incidence, predictors, and prognostic impact of temporary left bundle branch block after transcatheter aortic valve replacement

Leone, Attilio; Castiello, Domenico Simone; Angellotti, Domenico; Mariani, Andrea; Manzo, Rachele; Avvedimento, Marisa; Ilardi, Federica; Piccolo, Raffaele; Esposito, Giovanni; Franzone, Anna

doi:10.1016/j.jelectrocard.2022.09.005

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Therefore, it should be noted that the present results are the result of a mixture of transient and persist postprocedural LBBB. It has been reported that transient LBBB is not associated with prognosis, 29 and our study may have included more transient LBBB than previous studies. In addition, new onset LBBB is caused by mechanical compression of the conduction system by a prosthetic valve, but pre-existing LBBB is due to a failure of one's own conduction system, which may be hiding cardiomyopathy or other problems that were not fully understood in our study, which may have led to our results.…”

Section: Discussionmentioning

confidence: 97%

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Saito,

Inohara,

Tsuruta

et al. 2024

JACC: Asia

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Section: Discussionmentioning

confidence: 97%

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Saito,

Inohara,

Tsuruta

et al. 2024

JACC: Asia

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“…We also excluded patients with transient LBBB as these patients were shown to have similar outcomes in terms of mortality and PPM requirement compared to patients who did not develop a LBBB. 16 It is also unclear if a prolonged PR interval before or immediately after TAVR is predictive of HAVB development. The PR interval is more prolonged in the PPM-necessary group, but this may simply be related to how the PPM-necessary group was defined, which was by the percentage of ventricular pacing and would be expected to be higher in patients with a longer PR.…”

Section: Limitationsmentioning

confidence: 99%

“…Another reason for the relatively small number of study subjects was the rather low incidence of NP‐LBBB following TAVR at our center. We also excluded patients with transient LBBB as these patients were shown to have similar outcomes in terms of mortality and PPM requirement compared to patients who did not develop a LBBB 16 . It is also unclear if a prolonged PR interval before or immediately after TAVR is predictive of HAVB development.…”

Section: Limitationsmentioning

confidence: 99%

Electrophysiological evaluation following development of new and persistent left bundle branch block after transcatheter aortic valve replacement: A single center pilot study

Patel

Tsai

Atallah

et al. 2023

Pacing Clinical Electrophis

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IntroductionNew and persistent left bundle branch block (NP‐LBBB) following Transcatheter Aortic Valve Replacement (TAVR) is an ongoing concern with incidence ranging from as low as 4% to up to 65% (varying for different types of valves). Such patients are at risk of developing high‐grade atrioventricular block (HAVB) warranting permanent pacemaker (PPM) implantation. However, currently, there are no consensus guidelines or large prospective studies to risk stratify these patients for safer discharge after TAVR.ObjectivesTo provide insight from a single center study on using modified electrophysiology (EP) study to risk stratify post‐TAVR patients to outpatient monitoring for low‐risk versus pacemaker implantation for high‐risk patients.Methods and ResultsBetween June 2020 and March 2023, all patients who underwent a TAVR procedure (324 patients) at our institution were screened for development of NP‐LBBB post‐operatively. Out of 26 patients who developed NP‐LBBB, after a pre‐specified period of observation, 18 patients were deemed eligible for a modified EP study to assess His‐Ventricular (HV) interval. 11 out of 18 patients (61.1%) had normal HV interval (HV < 55 ms). Three out of 18 patients (16.7%) had HV prolongation (55 ms < HV < 70 ms) without significant HV prolongation (defined as an increase in HV interval > 30%) with intra‐procedural procainamide challenge. Four out of 18 patients (22.2%) had significant HV prolongation (HV > 70 ms) warranting PPM implantation based on a multidisciplinary approach and shared decision‐making with the patients. Total of 50% of patients discharged with PPM (two out of four patients) were noted to be pacemaker dependent based on serial device interrogations. All patients who did not receive PPM were discharged with ambulatory monitoring with 30‐day event monitor and did not develop HAVB on serial follow‐up.ConclusionNormal HV interval up to 55 ms on modified EP study after TAVR and development of NP‐LBBB can be utilized as a threshold for risk stratification to facilitate safe discharge. The optimal upper limit of HV interval threshold remains unclear in determining appropriate candidacy for PPM.

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Pre-existing left bundle branch block and clinical outcomes after transcatheter aortic valve replacement

Saito

Inohara

Tsuruta

et al. 2023

Preprint

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Background There are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB. This study aimed to investigate the association with pre-existing or new-onset LBBB and clinical outcomes after TAVR. Methods Using data from the Japanese multicenter registry, 5996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportinal hazard models and propensity score analysis to adjust the differences in baseline characteristics. Results Of 5996 patients who underwent TAVR, 280 patients (4.6%) had pre-existing LBBB and new onset LBBB occurred in 1658 patients (27.6%). Compared with no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated with a higher 2-year all-cause (adjusted hazard ratio [aHR]: 1.39; 95% confidence interval [CI]: 1.06-1.82; p =0.015) and cardiovascular mortality (aHR: 1.62; 95% CI: 1.05-2.54; p =0.027), but also with higher all-cause (aHR:1.43, 95% CI:1.07-1.91; p =0.016) and cardiovascular mortality (aHR: 1.84, 95% CI: 1.14-2.98; p =0.012) than new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group. Conclusions Pre-existing LBBB was independently associated with poor clinical outcomes reflecting increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.

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Incidence, predictors, and prognostic impact of temporary left bundle branch block after transcatheter aortic valve replacement

Cited by 4 publications

References 5 publications

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Electrophysiological evaluation following development of new and persistent left bundle branch block after transcatheter aortic valve replacement: A single center pilot study

Pre-existing left bundle branch block and clinical outcomes after transcatheter aortic valve replacement

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