Isogai Toshiaki, Dykun Iryna, Agrawal Ankit, Shekhar Shashank, Tarakji Khaldoun G, Wazni Oussama M, Kalra Ankur, Krishnaswamy Amar, Reed Grant W, Kapadia Samir R, Puri Rishi
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Am J Cardiol. 2022 Apr 1;168:117-127. doi: 10.1016/j.amjcard.2021.12.032. Epub 2022 Jan 16.
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.
新发左束支传导阻滞（LBBB）在经导管主动脉瓣植入术（TAVI）后很常见，但在TAVI术后可能会缓解。我们试图研究接受SAPIEN 3（S3）瓣膜的TAVI患者中新发LBBB早期缓解的发生率、预测因素和结局。在2016年至2019年间于我们机构接受S3-TAVI且术前无起搏器或宽QRS波群的1203例患者中，我们确定了143例在TAVI期间发生新发LBBB的患者，并根据TAVI术后次日LBBB的缓解或持续情况将他们分组，以比较高度房室传导阻滞（HAVB）和永久起搏器（PPM）的植入率。LBBB缓解的患者（n = 74，52%）与LBBB持续的患者相比，女性更多见，基线和TAVI术后的QRS时限更短，S3瓣膜尺寸更小，植入深度更浅。多变量逻辑回归模型显示，TAVI术后QRS时限（每增加10 ms，比值比 = 0.60 [95%置信区间 = 0.44至0.82]）和植入深度（每增加1 mm深度，0.77 [0.61至0.97]）与LBBB缓解的可能性较低显著相关。LBBB缓解的患者在TAVI术后30天内均未发生HAVB。同时，8例（11.6%）LBBB持续的患者发生了HAVB。LBBB持续组的2年PPM植入率显著高于LBBB缓解组（30.3%对4.5%，对数秩检验p <0.001），主要是由30天PPM植入率较高（18.8%对0.0%）所致。总之，S3-TAVI期间发生的新发LBBB约有一半在TAVI术后次日缓解，且无HAVB发生。相比之下，新发持续性LBBB可能因有HAVB风险而需要在30天内进行动态监测随访。
