Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Am J Cardiol. 2022 Apr 1;168:117-127. doi: 10.1016/j.amjcard.2021.12.032. Epub 2022 Jan 16.

Abstract

New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis*
  • Arrhythmias, Cardiac / complications
  • Atrioventricular Block* / epidemiology
  • Atrioventricular Block* / etiology
  • Atrioventricular Block* / therapy
  • Bundle-Branch Block / epidemiology
  • Bundle-Branch Block / etiology
  • Bundle-Branch Block / therapy
  • Female
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Pacemaker, Artificial* / adverse effects
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome