Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study

• Published in: Heart Rhythm Vol. 20; no. 5; pp. 699 - 706
• Main Authors: Massoullié, Grégoire, Ploux, Sylvain, Souteyrand, Géraud, Mondoly, Pierre, Pereira, Bruno, Amabile, Nicolas, Jean, Frédéric, Irles, Didier, Mansourati, Jacques, Combaret, Nicolas, Mechulan, Alexis, Badoz, Marc, Da Costa, Antoine, Defaye, Pascal, Motreff, Pascal, Clerfond, Guillaume, Bordachar, Pierre, Eschalier, Romain
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023; Elsevier BV; Elsevier
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis; Aortic Valve Stenosis - surgery; Atrioventricular Block; Atrioventricular Block - diagnosis; Atrioventricular Block - epidemiology; Atrioventricular Block - etiology; Bundle-Branch Block; Bundle-Branch Block - diagnosis; Bundle-Branch Block - epidemiology; Bundle-Branch Block - etiology; Cardiac Conduction System Disease; Cardiac Conduction System Disease - diagnosis; Cardiac Conduction System Disease - epidemiology; Cardiac Conduction System Disease - therapy; Cardiac electrophysiology studies; Electrocardiography; Humans; Incidence; Left bundle branch block; Life Sciences; Pacemaker; Pacemaker, Artificial; Pacemaker, Artificial - adverse effects; Prospective Studies; TAVR; Transcatheter Aortic Valve Replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Cardiac electrophysiology studies; Left bundle branch block; Pacemaker; TAVR; Atrioventricular block
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2023.01.013

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. 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). 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. 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). 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. [Display omitted]