Late Electrocardiographic Changes in Patients With New-Onset Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation - 10/02/20

Doi : 10.1016/j.amjcard.2019.11.025

Laurent Faroux, MD, MSc ^a,^{^{#
Both authors equally contributed to this work.}}, Guillem Muntané-Carol, MD ^a,^{^{#
Both authors equally contributed to this work.}}, Marina Urena, MD, PhD ^b, Luis Nombela-Franco, MD, PhD ^c, Ignacio Amat-Santos, MD, PhD ^d, Neal Kleiman, MD ^e, Antonio Munoz-Garcia, MD, PhD ^f, Felipe Atienza, MD, PhD ^g, Vicenç Serra, MD ^h, Marc W. Deyell, MD ⁱ, Gabriela Veiga-Fernandez, MD ^j, Jean-Bernard Masson, MD ^k, Victoria Canadas-Godoy, MD ^c, Dominique Himbert, MD ^b, Quentin Fischer, MD ^b, Javier Castrodeza, MD ^d, Jaime Elizaga, MD ^g, Jaume Francisco Pascual, MD ^h, John G. Webb, MD ⁱ, Jose M. de la Torre, MD ^j, Lluis Asmarats, MD ^a, Emilie Pelletier-Beaumont, MSc ^a, Marcel Alméndarez, MD ^a, Thomas Couture, MS ^a, Francois Philippon, MD ^a, Josep Rodes-Cabau, MD ^a,^⁎
^a Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
^b Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
^c Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
^d Hospital Universitario de Valladolid, Valladolid, Spain
^e Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
^f Hospital Virgen de la Victoria, Malaga, Spain
^g Hospital General Universitario Gregorio Maranon, Madrid, Spain
^h Hospital Universitari Vall d'Hebron, Barcelona, Spain
ⁱ St. Paul's Hospital, Vancouver, British Columbia, Canada
^j Hospital Universitario Marques de Valdecilla, Santander, Spain
^k Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada

^⁎Corresponding author: Tel: (418) 656-8711; fax: (418) 656-4544

Résumé

This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.

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Vol 125 - N° 5

P. 795-802 - mars 2020 Retour au numéro

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Late Electrocardiographic Changes in Patients With New-Onset Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation - 10/02/20

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