Late arrhythmias in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement using a balloon-expandable valve

Guillem Muntané-Carol, Luis Nombela-Franco, Vicenç Serra, Marina Urena, Ignacio Amat-Santos, Victoria Vilalta, Chekrallah Chamandi, Thibault Lhermusier, Gabriela Veiga-Fernandez, Neal Kleiman, Victoria Canadas-Godoy, Jaume Francisco-Pascual, Dominique Himbert, Javier Castrodeza, Eduard Fernandez-Nofrerias, Pierre Baudinaud, Pierre Mondoly, Francisco Campelo-Parada, Jose M. De la Torre Hernandez, Emilie Pelletier-BeaumontFrançois Philippon, Josep Rodés-Cabau

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: The arrhythmic burden after discharge in patients with new-onset left bundle branch block (LBBB) undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 (S3) valve remains largely unknown. Objective: The purpose of this study was to determine the incidence of late arrhythmias in patients with new-onset LBBB undergoing TAVR with the balloon-expandable S3 valve. Methods: This was a multicenter, prospective study that included 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. An implantable cardiac monitor (Reveal XT, Reveal LINQ) was implanted before discharge. The primary endpoint was the incidence of high-degree atrioventricular block or complete heart block (HAVB/CHB). Results: A total of 40 patients (38.5%) had at least 1 significant arrhythmic event, leading to a treatment change in 17 (42.5%). Significant bradyarrhythmias occurred in 20 of 104 patients (19.2%) (34 HAVB/CHB episodes, 252 severe bradycardia episodes), with 10 of 20 patients (50%) exhibiting at least 1 episode of HAVB/CHB. Most HAVB/CHB episodes (60%) occurred within 4 weeks after discharge. Nine patients (8.7%) underwent permanent pacemaker implantation at 12 months based on the Reveal findings (6 HAVB/CHB, 3 severe bradycardia). Conclusion: S3 valve recipients with new-onset LBBB have a high arrhythmic burden, with more than one-third of patients exhibiting at least 1 significant arrhythmic episode within 12 months (HAVB/CHB in 10% of patients). About one-half of bradyarrhythmic events occurred within 4 weeks after discharge. These results should inform future strategies on the use of continuous electrocardiographic monitoring in TAVR S3 patients with new conduction disturbances following the procedure.

Original languageEnglish (US)
Pages (from-to)1733-1740
Number of pages8
JournalHeart Rhythm
Volume18
Issue number10
DOIs
StatePublished - Oct 2021

Keywords

  • Atrial fibrillation
  • Bradyarrhythmia
  • Left bundle branch block
  • Pacemaker implantation
  • SAPIEN 3
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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