Mas-Peiro Silvia, Lhermusier Thibault, Urena Marina, Nombela-Franco Luis, Vilalta Victoria, Muñoz-Garcia Antonio, Amat-Santos Ignacio, Atienza Felipe, Kleiman Neal, Chamandi Chekrallah, Serra Vicenç, Deyell Marc W, Campelo-Parada Francisco, Mondoly Pierre, Suc Gaspard, Canadas-Godoy Victoria, Fernandez-Nofrerias Eduard, Castrodeza Javier, Elizaga Jaime, Baudinaud Pierre, Francisco Pascual Jaume, Webb John G, Pelletier-Beaumont Emilie, Philippon François, Rodés-Cabau Josep
Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V4G5.
Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France.
Europace. 2025 Mar 28;27(4). doi: 10.1093/europace/euaf057.
Arrhythmic burden after discharge in patients with new-onset persistent left bundle branch block (NOP-LBBB) following transcatheter aortic valve replacement (TAVR) with Evolut devices remains largely unknown. The aim of this study is to assess the incidence and type of arrhythmias at 2-year follow-up in patients with NOP-LBBB post-TAVR.
This is a prospective multicentre study including 88 patients with LBBB persisting for ≥3 days post-implantation. Before discharge, an implantable loop recorder (REVEAL XT/LINQ) was implanted; patients had continuous monitoring for 2 years. Arrhythmic events were adjudicated in a central core lab. Of the arrhythmic events, 411 were detected in 58 patients [65.9%; 2 (1-4) events per patient]. Symptoms were reported in 12/58 (20.7%), and therapy was changed in 25/58 (43.1%). There were 101 bradyarrhythmic events in 33 patients [35 high-grade atrioventricular block (HAVB) and 66 severe bradycardia]. The HAVB incidence was higher in the early (4-week) phase and remained stable over time, whereas severe bradycardia increased after 1 year. Permanent pacemaker was required in 11 (12.5%) patients (6.8% and 5.7% in the first and second year, respectively). There were 310 tachyarrhythmic events in 29 patients (120 AF/AFL, 111 AT, 72 SVT, 6 NSVT, and 1 VT); its incidence decreased throughout the 2 years. New AF/AFL episodes occurred in 20/69 patients [29%; symptomatic in 2/20 (10%)].
Patients with NOP-LBBB post-TAVR with Evolut devices exhibited a high burden of late arrhythmias, with events occurring in two-thirds of patients and leading to treatment changes in about half of them. These data should inform future studies on cardiac monitoring devices for follow-up and treatment optimization in this challenging population.
采用Evolut装置进行经导管主动脉瓣置换术（TAVR）后，新发持续性左束支传导阻滞（NOP-LBBB）患者出院后的心律失常负担仍很大程度上未知。本研究的目的是评估TAVR术后NOP-LBBB患者在2年随访时心律失常的发生率和类型。
这是一项前瞻性多中心研究，纳入88例植入后左束支传导阻滞持续≥3天的患者。出院前，植入了植入式环路记录仪（REVEAL XT/LINQ）；患者进行了2年的连续监测。心律失常事件在中央核心实验室进行判定。在心律失常事件中，58例患者检测到411次事件[65.9%；每位患者2（1-4）次事件]。12/58（20.7%）患者报告有症状，25/58（43.1%）患者治疗方案发生改变。33例患者发生101次缓慢性心律失常事件[35次高度房室传导阻滞（HAVB）和66次严重心动过缓]。HAVB发生率在早期（4周）阶段较高，并随时间保持稳定，而严重心动过缓在1年后增加。11例（12.5%）患者需要植入永久性起搏器（第一年和第二年分别为6.8%和5.7%）。29例患者发生310次快速性心律失常事件（120次房颤/房扑、111次房性心动过速、72次室上性心动过速、6次非持续性室性心动过速和1次室性心动过速）；其发生率在2年期间持续下降。20/69例患者出现新发房颤/房扑发作[29%；2/20（10%）有症状]。
采用Evolut装置进行TAVR术后的NOP-LBBB患者表现出较高的晚期心律失常负担，三分之二的患者发生事件，约一半患者因此改变治疗方案。这些数据应为今后针对这一具有挑战性人群进行心脏监测装置随访及治疗优化的研究提供参考。
