Key result
New-onset LBBB post-TAVR links to high arrhythmic burden, with ~17% requiring permanent pacing.
Why the study?
The incidence and type of arrhythmias in patients with new-onset persistent LBBB after TAVR over a 2-year period were not well characterized.
Cohort (n=103)
Yes
Answers are grounded in this paper and cite their sources.
Continuous monitoring of patients with new-onset LBBB post-TAVR shows a high overall arrhythmic burden at 2 years, but high-degree AV block requiring pacing occurs almost exclusively early post-procedure.
AIMS: We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year. CONCLUSION: Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307).
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Muntané‐Carol et al. (2020) conducted a cohort in New-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) (n=103). New-onset persistent LBBB post-TAVR was evaluated on Incidence and type of arrhythmias at 2-year follow-up. Patients with new-onset LBBB post-TAVR exhibited a high arrhythmic burden over 2 years (1836 events), with 17% requiring a permanent pacemaker or ICD, predominantly in the early post-TAVR phase.
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