scholarly journals Non-invasive electrocardiographic imaging of dynamic atrioventricular delay programming in a patient with left bundle-branch block

2021 ◽  
Author(s):  
Peter H. Waddingham ◽  
Jan Mangual ◽  
Michele Orini ◽  
Nima Badie ◽  
Luke McSpadden ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Atrioventricular Delay

Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR

2021 ◽  
Author(s):  
Chloé Auberson ◽  
Patrick Badertscher ◽  
Antonio Madaffari ◽  
Meriton Malushi ◽  
Luc Bourquin ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Predictive Value ◽  
Conduction Delay ◽  
Bundle Branch Block ◽  
Non Invasive ◽  
Transcatheter Aortic Valve ◽  
Increased Risk ◽  
Surface Ecg ◽  
Pr Interval ◽  
Electrocardiographic Parameters

Abstract Aims Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB. Methods We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval > 55 ms. Results Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 123), ΔPR (OR per 10 ms increase: 1.52; 95%CI: 1.19–2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. A change in PR interval by 20 ms yielded a specificity of 83% and a sensitivity of 46%, with a negative predictive value of 84% and a positive predictive value of 45% to predict HV prolongation. Conclusions Simple analysis of surface ECG and a calculated ΔPR < 20 ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Graphical abstract

scholarly journals Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Auberson ◽  
P Badertscher ◽  
A Madaffari ◽  
M Malushi ◽  
L Bourquin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Left Bundle Branch Block ◽  
Predictive Value ◽  
Transcatheter Aortic Valve Replacement ◽  
Conduction Delay ◽  
Bundle Branch Block ◽  
Non Invasive ◽  
Transcatheter Aortic Valve ◽  
Pr Interval

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB. Methods We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval &gt;55 ms. Results Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 131), ΔPR (OR per 10 ms increase: 1.52; 95% CI: 1.19-2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. The AUC of the ROC curve was 0.724 (95% CI) for ΔPR. A change in PR interval by 20 ms yielded a sensitivity of 26% and specificity of 83% with a positive predictive value of 45% and a negative predictive value of 84% to predict HV prolongation. Conclusions Simple analysis of surface ECG and a calculated ΔPR &lt;20ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Abstract Figure HV

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