Key result
Transcatheter aortic valve implantation resulted in LBBB in ~70% of patients with a baseline narrow QRS, with similar incidence regardless of prior balloon aortic valvuloplasty (65.3% vs 74.2%; p=0.494).
Why the study?
Conduction disturbances such as LBBB and cAVB frequently complicate TAVI, prompting investigation into their dynamics to understand luxating factors and predictors for persistency.
What are the dynamics and predictors of persistency for conduction disturbances during and after TAVI?
Cohort (n=157)
What are the dynamics and predictors of persistency for conduction disturbances during and after TAVI?
Absolute Event Rate: 65.3% vs 74.2%
p-value: p=0.494
Conduction disturbances during TAVI are highly dynamic, with most bundle branch blocks being reversible, but patients with super-transient LBBB or preexisting abnormalities are at highest risk for progressing to complete AV block.
High post-TAVI LBBB incidence warrants close conduction monitoring; leaves open predictors of persistence in prospective cohorts.
Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.
No takes yet. Share an insight, caveat, or question.
Poels et al. (2021) conducted a cohort in Conduction disturbances following transcatheter aortic valve implantation (n=157). Transcatheter aortic valve implantation (TAVI) was evaluated on Incidence of LBBB with vs without balloon aortic valvuloplasty (BAV) prior to TAVI (p=0.494). Transcatheter aortic valve implantation resulted in LBBB in ~70% of patients with a baseline narrow QRS, with similar incidence regardless of prior balloon aortic valvuloplasty (65.3% vs 74.2%; p=0.494).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: