Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve

Urena, Marina, Mok, Michael, Serra, Vicenç, Dumont, Eric, Nombela-Franco, Luis, DeLarochellière, Robert, Doyle, Daniel, Igual, Albert, Larose, Eric, Amat-Santos, Ignacio, Côté, Mélanie, Cuéllar, Hug, Pibarot, Philippe, de Jaegere, Peter, Philippon, François, Garcia del Blanco, Bruno and Rodés-Cabau, Josep 2012, Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve, Journal of the American college of cardiology, vol. 60, no. 18, pp. 1743-1752, doi: 10.1016/j.jacc.2012.07.035.

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Title Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve
Author(s) Urena, Marina
Mok, MichaelORCID iD for Mok, Michael
Serra, Vicenç
Dumont, Eric
Nombela-Franco, Luis
DeLarochellière, Robert
Doyle, Daniel
Igual, Albert
Larose, Eric
Amat-Santos, Ignacio
Côté, Mélanie
Cuéllar, Hug
Pibarot, Philippe
de Jaegere, Peter
Philippon, François
Garcia del Blanco, Bruno
Rodés-Cabau, Josep
Journal name Journal of the American college of cardiology
Volume number 60
Issue number 18
Start page 1743
End page 1752
Total pages 10
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2012-10-30
ISSN 0735-1097
Keyword(s) Aged
Aged, 80 and over
Angioplasty, Balloon
Aortic Valve
Aortic Valve Stenosis
Atrioventricular Block
Bundle-Branch Block
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Time Factors
Treatment Outcome
Ventricular Function, Left
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
conduction disturbances
left bundle branch block
transcatheter aortic valve implantation
transcatheter aortic valve replacement
Summary 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.
Language eng
DOI 10.1016/j.jacc.2012.07.035
Field of Research 110201 Cardiology (incl Cardiovascular Diseases)
1102 Cardiovascular Medicine And Haematology
1117 Public Health And Health Services
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2012, the American College of Cardiology Foundation
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Document type: Journal Article
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