Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI : A prospective multicenter study
Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved..
BACKGROUND: New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block.
OBJECTIVES: The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR).
METHODS: This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring.
RESULTS: A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P < .001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P = .010).
CONCLUSION: New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.
| Errataetall: |
CommentIn: Heart Rhythm. 2023 May;20(5):707-708. - PMID 36720441 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Heart rhythm - 20(2023), 5 vom: 10. Mai, Seite 699-706 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Massoullié, Grégoire [VerfasserIn] |
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| Links: |
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| Themen: |
Atrioventricular block |
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| Anmerkungen: |
Date Completed 01.05.2023 Date Revised 02.05.2023 published: Print-Electronic CommentIn: Heart Rhythm. 2023 May;20(5):707-708. - PMID 36720441 Citation Status MEDLINE |
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| doi: |
10.1016/j.hrthm.2023.01.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Massoullié, Grégoire |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI |b A prospective multicenter study |
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| 500 | |a Date Completed 01.05.2023 | ||
| 500 | |a Date Revised 02.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Heart Rhythm. 2023 May;20(5):707-708. - PMID 36720441 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block | ||
| 520 | |a OBJECTIVES: The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR) | ||
| 520 | |a METHODS: This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring | ||
| 520 | |a RESULTS: A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P < .001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P = .010) | ||
| 520 | |a CONCLUSION: New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation | ||
| 650 | 4 | |a Multicenter Study | |
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| 650 | 4 | |a Cardiac electrophysiology studies | |
| 650 | 4 | |a Left bundle branch block | |
| 650 | 4 | |a Pacemaker | |
| 650 | 4 | |a TAVR | |
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