Arrhythmic Burden as Determined by Ambulatory Continuous Cardiac Monitoring in Patients With New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Replacement: The MARE Study

• Published in: JACC. Cardiovascular interventions Vol. 11; no. 15; pp. 1495 - 1505
• Main Authors: Rodés-Cabau, Josep, Urena, Marina, Nombela-Franco, Luis, Amat-Santos, Ignacio, Kleiman, Neal, Munoz-Garcia, Antonio, Atienza, Felipe, Serra, Vicenç, Deyell, Marc W, Veiga-Fernandez, Gabriela, Masson, Jean-Bernard, Canadas-Godoy, Victoria, Himbert, Dominique, Castrodeza, Javier, Elizaga, Jaime, Francisco Pascual, Jaume, Webb, John G, de la Torre, Jose Maria, Asmarats, Lluis, Pelletier-Beaumont, Emilie, Philippon, François
• Format: Journal Article
• Language: English
• Published: United States 13.08.2018
• Subjects: transcatheter aortic valve replacement; atrial fibrillation; left bundle branch block; bradyarrhythmias; pacemaker implantation
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2018.04.016

The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR. This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treatment change, and the incidence of HAVB at 12-month follow-up. A total of 1,553 new arrhythmic events were detected in 44 patients (1,443 episodes of tachyarrhythmia in 26 patients [atrial fibrillation/flutter/atrial tachycardia: 1,427, ventricular tachycardia 16]; 110 episodes of bradyarrhythmia in 21 patients [HAVB 54, severe bradycardia 56]). All arrhythmic events were silent in 34 patients (77%), the arrhythmic event led to a treatment change in 19 patients (18%), and 11 patients (11%) required pacemaker or implantable cardioverter-defibrillator implantation (due to HAVB, severe bradycardia, or ventricular tachycardia episodes in 9, 1, and 1 patient, respectively). A total of 12 patients died at 1-year follow-up, 1 from sudden death. A high incidence of arrhythmic events was observed at 1-year follow-up in close to one-half of the patients with LBBB post-TAVR. Significant bradyarrhythmias occurred in one-fifth of the patients, and PPM was required in nearly one-half of them. These data support the use of a cardiac monitoring device for close follow-up and expediting the initiation of treatment in this challenging group of patients. (Ambulatory Electrocardiographic Monitoring for the Detection of High-Degree Atrio-Ventricular Block in Patients With New-onset PeRsistent LEft Bundle Branch Block After Transcatheter Aortic Valve Implantation [MARE study]: NCT02153307).