A new electrocardiographic definition of left bundle branch block (LBBB) in patients after transcatheter aortic valve replacement (TAVR)
Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define...
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Published in | Journal of electrocardiology Vol. 63; pp. 167 - 172 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.11.2020
Elsevier Science Ltd |
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Abstract | Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB.
We screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected.
36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8–89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was −18° (IQR, −40–4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present.
We developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings.
•All LBBB patients had a notched/slurred R wave in at least one lateral lead.•All LBBB patients had R wave duration of ≤20 ms in V1 when present.•The minimum QRS duration with LBBB was 126 ms.•LBBB development post TAVR resulted in 18.5° leftward shift in axis.•The median QRS axis with LBBB was −18° and 39% had left axis deviation. |
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AbstractList | BACKGROUNDCurrent LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB. METHODSWe screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected. RESULTS36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8-89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was -18° (IQR, -40-4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present. CONCLUSIONWe developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings. Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB. We screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected. 36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8-89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was -18° (IQR, -40-4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present. We developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings. Background: Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB. Methods: We screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected. Results: 36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8–89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was −18° (IQR, −40–4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present. Conclusion: We developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings. Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB. We screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected. 36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8–89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was −18° (IQR, −40–4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present. We developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings. •All LBBB patients had a notched/slurred R wave in at least one lateral lead.•All LBBB patients had R wave duration of ≤20 ms in V1 when present.•The minimum QRS duration with LBBB was 126 ms.•LBBB development post TAVR resulted in 18.5° leftward shift in axis.•The median QRS axis with LBBB was −18° and 39% had left axis deviation. |
Author | Golian, Mehrdad Nair, Girish M. Alqarawi, Wael Davis, Darryl R. Birnie, David H. Nery, Pablo B. Sadek, Mouhannad M. Hibbert, Benjamin Green, Martin S. Redpath, Calum J. Klein, Andres |
Author_xml | – sequence: 1 givenname: Wael surname: Alqarawi fullname: Alqarawi, Wael organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 2 givenname: Mouhannad M. surname: Sadek fullname: Sadek, Mouhannad M. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 3 givenname: Mehrdad surname: Golian fullname: Golian, Mehrdad organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 4 givenname: Benjamin surname: Hibbert fullname: Hibbert, Benjamin organization: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 5 givenname: Calum J. surname: Redpath fullname: Redpath, Calum J. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 6 givenname: Girish M. surname: Nair fullname: Nair, Girish M. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 7 givenname: Pablo B. surname: Nery fullname: Nery, Pablo B. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 8 givenname: Darryl R. surname: Davis fullname: Davis, Darryl R. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 9 givenname: Andres surname: Klein fullname: Klein, Andres organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 10 givenname: David H. surname: Birnie fullname: Birnie, David H. organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada – sequence: 11 givenname: Martin S. surname: Green fullname: Green, Martin S. email: MGreen@ottawaheart.ca organization: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada |
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CitedBy_id | crossref_primary_10_1007_s10840_020_00902_y crossref_primary_10_1007_s12471_021_01565_8 crossref_primary_10_1016_j_hrthm_2023_09_004 crossref_primary_10_1111_pace_14840 |
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Keywords | ECG His bundle pacing Cardiac resynchronization therapy LBBB Transcatheter aortic valve replacement |
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Snippet | Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His... Background: Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize... BACKGROUNDCurrent LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize... |
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SubjectTerms | Cardiac arrhythmia Cardiac resynchronization therapy ECG Electrocardiography Heart attacks Heart surgery His bundle pacing LBBB Transcatheter aortic valve replacement |
Title | A new electrocardiographic definition of left bundle branch block (LBBB) in patients after transcatheter aortic valve replacement (TAVR) |
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