Predictive Factors and Long-Term Clinical Consequences of Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

M Urena, M Mok, V Serra, E Dumont, L Nombela-Franco, R DeLarochelliere, D Doyle, A Igual, E Larose, I Amat-Santos, M Cote, H Cuellar, P Pibarot, Peter de Jaegere, F Philippon, BG del Blanco, J Rodes-Cabau

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Abstract

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 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 wit 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. (J Am Coll Cardiol 2012;60:1743-52) (C) 2012 by the American College o
Original languageUndefined/Unknown
Pages (from-to)1743-1752
Number of pages10
JournalJournal of the American College of Cardiology
Volume60
Issue number18
DOIs
Publication statusPublished - 2012

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