Predictive Factors and Long-Term Clinical Consequences of Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Urena, Marina¹  Mok, Michael¹  Serra, Vicenc¹  Dumont, Eric¹  Nombela-Franco, Luis¹  DeLarochelliere, Robert¹  Doyle, Daniel¹  Igual, Albert²  Larose, Eric¹  Amat-Santos, Ignacio¹  Cote, Melanie¹  Cuellar, Hug²  Pibarot, Philippe¹  de Jaegere, Peter³  Philippon, Francois¹  Garcia del Blanco, Bruno²  Rodes-Cabau, Josep¹ 

[1] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ G1V 4G5, Canada

[2] Vall dHebron Univ Hosp, Dept Cardiol, Barcelona, Spain

[3] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands

关键词: conduction disturbances;    left bundle branch block;    pacemaker;    transcatheter aortic valve implantation;    transcatheter aortic valve replacement;   

DOI  :  10.1016/j.jacc.2012.07.035

来源: Elsevier

【 摘 要 】

Objectives This study evaluated the predictive factors and prognostic value of new-onset persistent left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve implantation (TAVI) with a balloon-expandable valve. Background The predictors of persistent (vs. transient or absent) LBBB after TAVI with a balloon-expandable valve and its clinical consequences are unknown. Methods A total of 202 consecutive patients with no baseline ventricular conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent TAVI with a balloon-expandable valve were included. Patients were on continuous electrocardiographic (ECG) monitoring during hospitalization and 12-lead ECG was performed daily until hospital discharge. No patient was lost at a median follow-up of 12 (range: 6 to 24) months, and ECG tracing was available in 97% of patients. The criteria for PPI were limited to the occurrence of high-degree atrioventricular block (AVB) or severe symptomatic bradycardia. Results New-onset LBBB was observed in 61 patients (30.2%) after TAVI, and had resolved in 37.7% and 57.3% at hospital discharge and 6- to 12-month follow-up, respectively. Baseline QRS duration (p = 0.037) and ventricular depth of the prosthesis (p = 0.017) were independent predictors of persistent LBBB. Persistent LBBB at hospital discharge was associated with a decrease in left ventricular ejection fraction (p = 0.001) and poorer functional status (p = 0.034) at 1-year follow-up. Patients with persistent LBBB and no PPI at hospital discharge had a higher incidence of syncope (16.0% vs. 0.7%; p = 0.001) and complete AVB requiring PPI (20.0% vs. 0.7%; p < 0.001), but not of global mortality or cardiac mortality during the follow-up period (all, p > 0.20). New-onset LBBB was the only factor associated with PPI following TAVI (p < 0.001). Conclusions Up to 30% of patients with no prior conduction disturbances developed new LBBB following TAVI with a balloon-expandable valve, although it was transient in more than one third. Longer baseline QRS duration and a more ventricular positioning of the prosthesis were associated with a higher rate of persistent LBBB, which in turn determined higher risks for complete AVB and PPI, but not mortality, at 1-year follow-up. (J Am Coll Cardiol 2012;60:1743-52) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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