Key result
Aortic valve implantation-induced LBBB exhibits 100% lateral QRS notching and higher ESC concordance versus controls.
Why the study?
New-onset LBBB following aortic valve replacement implies a proximal pathogenesis, motivating a comparison of ECG characteristics and diagnostic concordance with non-procedure-induced LBBB.
Does aortic valve implantation-induced LBBB differ in electrocardiographic characteristics and concordance with LBBB definitions compared to non-procedure-induced LBBB?
Case-Control (n=177)
No
Does aortic valve implantation-induced LBBB differ in electrocardiographic characteristics and concordance with LBBB definitions compared to non-procedure-induced LBBB?
Lateral QRS notching/slurring is an essential criterion for diagnosing proximal LBBB, and AVI-induced LBBB provides a framework for uniform criteria for true proximal LBBB.
Highlights distinct ECG patterns in AVI-induced LBBB; leaves open uniform proximal LBBB criteria pending validation.
Introduction New-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBB AVI ) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBB AVI and non-procedure-induced LBBB controls (LBBB control ). Methods All LBBB AVI patients at Ghent University Hospital between 2013 and 2019 were enrolled in the study. LBBB AVI patients were matched for age, sex, ischaemic heart disease and ejection fraction to LBBB control patients in a 1:2 ratio. For inclusion, a non-strict LBBB definition was used (QRS duration ≥ 120 ms, QS or rS in V1, absence of Q waves in V5-6). Electrocardiograms were digitally analysed and classified according to three LBBB definitions: European Society of Cardiology (ESC), Strauss and American Heart Association (AHA). Results A total of 177 patients (59 LBBB AVI and 118 LBBB control ) were enrolled in the study. LBBB AVI patients had more lateral QRS notching/slurring (100% vs 85%, p = 0.001), included a higher percentage with a QRS duration ≥ 130 ms (98% vs 86%, p = 0.007) and had a less leftward oriented QRS axis (−15° vs −30°, p = 0.013) compared to the LBBB control group. ESC and Strauss criteria were fulfilled in 100% and 95% of LBBB AVI patients, respectively, but only 18% met the AHA criteria. In LBBB control patients, concordance with LBBB definitions was lower than in the LBBB AVI group: ESC 85% ( p = 0.001), Strauss 68% ( p < 0.001) and AHA 7% ( p = 0.035). No differences in electrocardiographic characterisation or concordance with LBBB definitions were observed between LBBB AVI and LBBB control patients with lateral QRS notching/slurring. Conclusion Non-uniformity exists among current LBBB definitions concerning the detection of proximal LBBB. LBBB AVI may provide a framework for more consensus on defining proximal LBBB.
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Calle et al. (2021) conducted a case-control in Left bundle branch block (n=177). Aortic valve implantation-induced LBBB vs. Non-procedure-induced LBBB controls was evaluated on Lateral QRS notching/slurring (p=0.001). Aortic valve implantation-induced LBBB patients exhibited 100% lateral QRS notching/slurring and higher concordance with ESC criteria compared to 85% in non-procedure-induced LBBB controls.
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