Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation

Abstract

TAVI-induced new LBBB occurs in almost 40% of patients, almost all before hospital discharge. It occurs three times more frequently after MCS than after ES valve implantation and has a twofold lower tendency to resolve during follow-up. Persistent LBBB is associated with a higher mortality.

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

“…The diagnosis criteria for LBBB were based on the recommendations from the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society 20 in 4 studies 3,4,13,18 and from the World Health Organizational/International Society and Federation for Cardiology 21 in 2 studies. 11,19 One study 12 did not detail the diagnosis criteria.…”

“…High heterogeneity was observed (I 2 = 83%, P = 0.001). Self-expandable balloon was a risk of both NOP-LBBB and PPI, 11,18 and we consider that the significant heterogeneity is mainly because the implanted prosthesis differs considerably among studies, as summarized in the Table 1. The main risks for PPI after TAVI include preexistent right bundle branch block, self-expandable prosthesis valve, and depth of implantation.…”

“…Results of the study by Houthuizen et al showed a significant increase in mortality in the NOP-LBBB group, when NOP-LBBB was defined as LBBB persisting during 1-year follow-up. 18 Furthermore, TAVI patients with underlying chronic LBBB have increased 1-year mortality. 38 This finding may also support the idea that unclear persistency of NOP-LBBB may be one of the reasons for inconsistency of mortality in NOP-LBBB following TAVI.…”

Transcatheter Aortic Valve Replacement Indications Should Not Be Expanded to Lower-Risk and Younger Patients

“…Implantation of the Medtronic CoreValve System more frequently led to new lBBB than implantation of the balloon-expandable Edwards SAPIEN valve (53.8% versus 21.7%) with less recovery during follow-up (39.0% versus 9.5%). 36 In the Houthuizen et al 36 study, which had a much longer follow-up than previous trials (median follow-up, 915 days [578-1234 days]), persistent lBBB was also associated with a significant increase in mortality compared with the absence of lBBB and temporary lBBB combined (HR, 1.49; 95% CI, 1.10-2.03; P=0.01). 36 In the GARY registry, the rate of new pacemaker implantation after SAVR was 4.6% as opposed to 23.6% after transfemoral TAVR.…”

Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol

“…Houthuizen et al [31] reported that approximately 40% of patients developed a new LBBB after TAVR of which most persisted at follow-up, however without the need for pacemaker implantation. In another analysis, a proportion of AV conduction disturbances after the intervention has been shown to recover at 3 months of follow-up, and only 40% of the permanent pacemaker patients for highdegree AV block still had an AV block underlying their paced rhythm [32].…”