Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

• Published in: The American journal of cardiology Vol. 168; pp. 117 - 127
• Main Authors: Isogai, Toshiaki, Dykun, Iryna, Agrawal, Ankit, Shekhar, Shashank, Tarakji, Khaldoun G., Wazni, Oussama M., Kalra, Ankur, Krishnaswamy, Amar, Reed, Grant W., Kapadia, Samir R., Puri, Rishi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022; Elsevier Limited
• Subjects: Aorta; Aortic valve; Aortic Valve - surgery; Aortic Valve Stenosis; Arrhythmias, Cardiac - complications; Atrioventricular Block - epidemiology; Atrioventricular Block - etiology; Atrioventricular Block - therapy; Bundle-Branch Block - epidemiology; Bundle-Branch Block - etiology; Bundle-Branch Block - therapy; Confidence intervals; Electrocardiography; Electronic health records; Female; Heart; Heart Valve Prosthesis - adverse effects; Heart valves; Humans; Implantation; Medical records; Pacemaker, Artificial - adverse effects; Pacemakers; Patients; Regression models; Statistical analysis; Transcatheter Aortic Valve Replacement - adverse effects; Transplants & implants; Treatment Outcome; Variables; United States > US; California
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2021.12.032

New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.