Prophylactic Permanent Pacemaker Implantation in Patients With Right Bundle Branch Block Undergoing TAVR

2021 ◽  
Vol 14 (11) ◽  
pp. 1272-1274
Author(s):  
Motoki Fukutomi ◽  
Thijmen Hokken ◽  
Ivan Wong ◽  
Gintautas Bieliauskas ◽  
Joost Daemen ◽  
...  
Keyword(s):  
Right Bundle Branch Block ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
Permanent Pacemaker Implantation

scholarly journals Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report

2020 ◽  
Author(s):  
Markus Bettin ◽  
Matthias Koopmann ◽  
Gerold Mönnig ◽  
Christian Pott
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Sudden Cardiac Arrest ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
Permanent Pacemaker Implantation ◽  
Idioventricular Rhythm

Abstract Background Accelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF). Case summary A 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death. Discussion Delayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.

scholarly journals 607 Comparison of incidence and predictors of new left bundle branch block and permanent pacemaker implantation in a large multicentre contemporary TAVI registry using the Evolut R/pro system vs. the accurate neo valve

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Sticchi ◽  
Francesco Gallo ◽  
Vincenzo De Marzo ◽  
Kim Won-keun ◽  
Arif A Khokhar ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Heart Valves ◽  
New Left ◽  
Pacemaker Implantation ◽  
Multivariate Regression Analysis ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
Permanent Pacemaker Implantation ◽  
Conduction Disorders ◽  
The Impact

Abstract Aims Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves. Methods and results We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI. Conclusions In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.

scholarly journals Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Oscar A. Mendiz ◽  
Marko Noč ◽  
Carlos M. Fava ◽  
Luis Abel Gutiérrez Jaikel ◽  
Matias Sztejfman ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Common Complication ◽  
Surgical Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Baseline Characteristics ◽  
Low Volume ◽  
New Onset

Background and Aim. Conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication for TAVR procedures, particularly when self-expanding valves are used. We compared the 30-day incidence of new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPMI) rate between two consecutive groups using either conventional 3-cusp coplanar view (CON) and right/left cusp-overlap view (COVL) for implantation. Methods and Results. We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p = 0.05 ) and PPMI rate (17.8% vs. 6.4%; p = 0.004 ) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). Conclusion. Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.

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