Early resolution of new-onset left bundle branch block after transcatheter aortic valve implantation with the SAPIEN 3 valve

By Isogai T, Dykun I, Agrawal A, et al
Published January 16, 2022

Key Takeaways

Findings demonstrate that approximately half of new-onset left bundle branch blocks (LBBBs) that were encountered during S3 (SAPIEN 3)-TAVI (transcatheter aortic valve implantation) resolved by the next day after TAVI without high-degree atrioventricular block (HAVB). In contrast, new-onset persistent LBBB could require follow-up with ambulatory monitoring within 30 days due to the HAVB risk.

  • In TAVI recipients with a S3 valve, the incidence, predictors, and outcomes of early resolution of new-onset LBBB were assessed.

  • This study included 143 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex who developed new-onset LBBB during TAVI; they were classified based on the resolution or persistence of LBBB by the next day post-TAVI.

  • More often female gender, and a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth, were noted in patients with resolved LBBB (n = 74, 52%) vs those with persistent LBBB.

  • In multivariable logistic regression model, post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60) and implantation depth (per 1-mm-depth-increase, 0.77) were found to be significantly associated with a lower likelihood of LBBB resolution.

  • Within 30 days after TAVI, HAVB did not occur in any of the patients with resolved LBBB.

  • Following persistent LBBB, vs after resolved LBBB, there was significantly higher 2-year permanent pacemaker (PPM) rate (30.3% vs 4.5%), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%).

Read the full article on The American Journal of Cardiology.

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