Clinical InvestigationValvular and Congenital Heart DiseaseIncidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement
Section snippets
Study population
This study is a retrospective observational ECG analysis of 115 consecutive patients with severe symptomatic aortic stenosis who received TAVR at Duke University Medical Center (Durham, NC) between April 2011 and February 2013. Forthy-four patients were excluded for the following reasons: a preexisting permanent pacemaker with ventricular-paced rhythm (n = 16); preexisting right bundle branch block (RBBB) (n = 16); preexisting LBBB, either nonstrict or strict (n = 8); or missing ECGs, either
Results
Three patients had a paced rhythm on the ECG taken 1-day postprocedure due to the presence of a new pacing requirement post-TAVR. These ECGs could not be classified, and the 3 patients were not included in the analysis. A total of 68 patients were included in the final analysis. Baseline characteristics of these 68 patients are presented in the Table. In this table, baseline characteristics are also grouped according to development of strict LBBB, nonstrict LBBB, and no LBBB after TAVR. No
Discussion
The main finding of the current study is that more than one-third of patients developed a strict LBBB 24 hours after TAVR, whereas only 2 patients developed a nonstrict LBBB. In addition, 25% of the patients with a new strict LBBB at 24 hours had resolution of the LBBB at 30-day follow-up ECG. Both patients with nonstrict LBBB showed resolution of the QRS widening at 1 month. These findings are consistent with the conclusion that factors such as baseline LVH and/or LAFB do not explain the
Conclusions
We found that approximately one-third of patients developed strict LBBB 1 day after the TAVR procedure, and 3% developed nonstrict LBBB. Baseline QRS duration did not predict the procedural development of strict LBBB. In approximately 25% of patients who developed an LBBB 24 hours after the procedure, the LBBB resolved at 1-month follow-up. Factors that were expected to influence the accuracy of LBBB diagnosis such as LAFB and LVH were rarely seen in this study. Future prospective studies with
Acknowledgements
The mention of commercial products, their sources, or their use in connection with material reported herein is not to be construed as either an actual or implied endorsement of such products by the Department of Health and Human Services.
References (26)
- et al.
Incidence, predictors, and outcome of conduction disorders after transcatheter self-expandable aortic valve implantation
- et al.
Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation
- et al.
Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve
J Am Coll Cardiol
(2012) - et al.
Defining left bundle branch block in the era of cardiac resynchronization therapy
Am J Cardiol
(2011) - et al.
Left ventricular mechanical dyssynchrony by cardiac magnetic resonance is greater in patients with strict vs nonstrict electrocardiogram criteria for left bundle-branch block
Am Heart J
(2013) Differentiation between left bundle branch block and left ventricular hypertrophy: implications for cardiac resynchronization therapy
J Electrocardiol
(2012)- et al.
From pressure overload to volume overload: aortic regurgitation after transcatheter aortic valve implantation
Am Heart J
(2012) - et al.
Impact of QRS duration and morphology on the risk of sudden cardiac death in asymptomatic patients with aortic stenosis: the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Study
J Am Coll Cardiol
(2012) - et al.
Electrocardiographic changes and clinical outcomes after transapical aortic valve implantation
Am Heart J
(2009) - et al.
Frequency of conduction disturbances after Edwards SAPIEN percutaneous valve implantation
Am J Cardiol
(2012)
The QRS complex—a biomarker that “images” the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction
J Electrocardiol
Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages
Am Heart J
Left bundle-branch block: the relationship between electrocardiogram electrical activation and echocardiography mechanical contraction
Am Heart J
Cited by (9)
Idiopathic/Iatrogenic Left Bundle Branch Block–Induced Reversible Left Ventricle Dysfunction: JACC State-of-the-Art Review
2018, Journal of the American College of CardiologyCitation Excerpt :Among 435 candidates for TAVR, a 3.5% rate of advanced atrioventricular block or LBBB was documented by 24-h ECG monitoring immediately before the procedure (40). Given the mechanical interaction usually involved, almost all patients exhibiting new-onset LBBB have “strict” LBBB (41), according to the ECG criteria recently proposed by Strauss (7). This observation may be of importance considering that patients with “strict” LBBB might have more pronounced LV dyssynchrony compared with their “nonstrict” LBBB counterparts and could potentially derive greater benefit from CRT.
Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis
2017, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Recent advances in TAVI,24 new techniques25,26 and sutureless valve insertions27,28 still carry a potential risk for conduction disorders leading to PPM implantation, given the close anatomic relationship between the aortic valve and the cardiac conduction system.29 TAVI and sutureless valve implantation was associated with a higher risk of PPM implantation and higher incidence of conduction disorders compared with surgical AVR with sutured valve implantation.24,28 TAVI recently has been considered in patients with low to intermediate operative risk.30
Dr. Galen Wagner (1939-2016) as an Academic Writer: An Overview of his Peer-reviewed Scientific Publications
2017, Journal of ElectrocardiologyGalen Wagner, M.D., Ph.D. (1939–2016) as international mentor of young investigators in electrocardiology
2017, Journal of ElectrocardiologyCitation Excerpt :Left ventricular mechanical dyssynchrony by cardiac magnetic resonance is greater in patients with strict vs nonstrict electrocardiogram criteria for left bundle-branch block [54]. Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement [100]. Selvester QRS scoring in conduction abnormalities: Caution recommended due to recent findings [238].
Immediate mechanical effects of acute left bundle branch block by speckle tracked strain
2015, Journal of ElectrocardiologyCitation Excerpt :The relationship between LBBB and mechanical response and the progressive impairment of LV function are not well proven in patients. The TAVR population represents an excellent human population to study the mechanical effects of LBBB because of the ability to precisely identify the time of onset of LBBB and because new EKG findings consistent with LBBB found immediately after TAVR can be safely assumed to represent true LBBB and not IVCD, which develops progressively over time [8]. The aim of this present study was to use the combined observations of these previous studies to explore the hypothesis that the acute onset of LBBB would result in acute mechanical changes in regional longitudinal strain compatible with the “classic” strain pattern which is thought to be caused by true LBBB.